Comparison of two modes of prescribing azithromycin with phenoxymethylpenicillin in the treatment of acute streptococcal tonsillopharyngitis
In studies of the effectiveness of using a 3-day course of azithromycin at a dose of 10 mg / kg / day in children with acute tosillopharyngitis caused by group A streptococci, contradictory microbiological results have been obtained.
In studies of the effectiveness of using a 3-day course of azithromycin at a dose of 10 mg / kg / day in children with acute tosillopharyngitis caused by group A streptococci, contradictory microbiological results have been obtained. In this regard, French scientists carried out a prospective multicentre comparative randomized study, the aim of which was to study the efficacy and tolerability of two courses of azithromycin (20 mg / kg / day and 10 mg / kg / day) compared to the standard 10-day schedule for phenoxymethylpenicillin.
During the study, the children underwent clinical and bacteriological examination on the 14th day and one month after the start of treatment. To compare strains of group A beta-hemolytic streptococci (BHSA), molecular methods were used before and after treatment.
Between November 1997 and July 1998, 501 patients aged 2 to 12 years participated in the study.
All patients were randomized into 3 groups: group 1 (169 people) received azithromycin at a dose of 10 mg / kg / day, group 2 (165 children) received azithromycin at a dose 20 mg / kg / day, and 167 patients in group 3 received phenoxymethylpenicillin. Before treatment, 25 of 315 strains of HBSS (7.9%) isolated from patients receiving azithromycin were resistant to this drug. At 14 days of the study, eradication of BSA was observed in 78 of 135 children (57.8%) who received azithromycin at a dose of 10 mg / kg / day, in 131 of 139 children (94.2%) who received azithromycin 20 mg / kg / day and 123 of 146 patients (84.2%) who received phenoxymethylpenicillin. One month after the start of treatment, a bacteriological relapse was observed in 40.5% (n = 30) of children who received azithromycin at a dose of 10 mg / kg / day, in 14.8% (n = 18) who received azithromycin at a dose of 20 mg / kg / day and in 13.5% of patients (n = 15) who received treatment with phenoxymethylpenicillin.
The results of treatment with azithromycin at a dose of 20 mg / kg / day were statistically significantly higher during azithromycin at a dose of 10 mg / kg / day in microbiological parameters on the 14th (p = 0.0001) and 30 days (p = 0.0001) from the start of treatment, and according to clinical parameters only on the 14th day (p = 0.0035). The course of azithromycin at a dose of 20 mg / kg / day at all stages of the study, both in microbiological and clinical parameters, coincided with standard treatment with phenoxymethylpenicillin. The number of adverse events occurring during treatment was comparable in the two groups receiving azithromycin (31 out of 169 (18.3%) in group 1, 37 out of 164 (23%) in group 2), but was significantly higher than in the phenoxymethylpenicillin group (5 of 166 (3%); p less than 0.0001). Most of the adverse events in the groups receiving azithromycin were noted in the gastrointestinal tract. 14 patients stopped participating in the study due to adverse events (1 child in group 3, 7 children in group 1 and 6 children in group 2).
This is the first study to demonstrate that the difference in daily dose of azithromycin affects the microbiological effectiveness of the treatment.
Thus, a 3-day azithromycin treatment with a dosage regimen of 20 mg / kg / day is more effective. that the appointment of azithromycin at a dose of 10 mg / kg / day in the treatment of tonsillopharyngitis caused by GBSA.