A double-blind, multicenter comparative study of two regimens of clindamycin hydrochloride in the treatment of patients with acute streptococcal tonsillitis/pharyngitis

Evaluation of 3-day azithromycin or 5-day cefaclor in comparison with 10-day amoxicillin for treatment of tonsillitis in children

To evaluate the clinical efficacy of azithromycin, cefaclor, and amoxicillin in treatment of pediatric tonsillitis, a total of 256 children with Group A β-hemolytic streptococcus (GAS) tonsillitis were randomly divided into 3 groups. Only patients assessed with streptococcus-positive tonsillitis, considered to be compliant with treatment and complete clinical and microbiological evaluations at the end of therapy (day 14) and follow-up (day 30) were included in the efficacy analysis. Our study demonstrated that 96.4% of patients in the azithromycin group, 92.4% of patients in the cefaclor group, and 91.0% of patients in the amoxicillin group were recorded as clinical success at the end of therapy. Bacteriological eradication rates of the 3 groups at the end of therapy were 94.0%, 89.9%, and 88.5%, respectively. A pathogen recurrence rate was evaluated as 2.6%, 7.0%, and 5.9% at the follow-up. Treatment-stimulated adverse events occurred in 2.4% of patients in the azithromycin group, 11.3% in the cefaclor group, and 11.4% in the amoxicillin group. In summary, azithromycin showed an effective tendency for the treatment of pediatric tonsillitis with lower occurrence rate of adverse reactions, although there is no statistical significance for the clinical and bacteriological eradication efficacy between these 3 groups.

A longer stay for the kissing disease: epidemiology of bacterial tonsillitis and infectious mononucleosis over a 20-year period

Introduction:

Anecdotally, infectious mononucleosis is considered a more severe infection than bacterial tonsillitis, requiring a longer hospital stay. However, there is little in the literature comparing the epidemiology of the two conditions. This study aimed to compare the epidemiology of bacterial tonsillitis and infectious mononucleosis, in particular any differences in the length of in-patient stay.

Methodology:

The hospital in-patient enquiry system was used to analyse patients admitted with bacterial tonsillitis and infectious mononucleosis between 1990 and 2009 inclusive.

Results:

There was a total of 3435 cases over the 20 years: 3064 with bacterial tonsillitis and 371 with infectious mononucleosis. The mean length of stay was 3.22 days for bacterial tonsillitis and 4.37 days for infectious mononucleosis. The median length of stay for each condition was compared using the Mann–Whitney U non-parametric test, and a significant difference detected (p < 0.001).

Conclusion:

Patients with infectious mononucleosis have a significantly longer stay in hospital than those with bacterial tonsillitis.

Oral clindamycin 300 mg BID compared with oral amoxicillin/clavulanic acid 1 g BID in the outpatient treatment of acute recurrent pharyngotonsillitis caused by group a β-hemolytic streptococci: An international, multicenter, randomized, investigator-blinded, prospective trial in patients between the ages of 12 and 60 years

BACKGROUND

The increasing rate of treatment failure with penicillin and other beta-lactam antibiotics in pharyngotonsillitis caused by group A beta-hemolytic streptococci (GABHS) has prompted the search for alternative antimicrobials. Both clindamycin and amoxicillin/clavulanic acid have excellent clinical activity in pharyngotonsillitis.

OBJECTIVE

This study compared the clinical and bacteriologic efficacy and tolerability of oral clindamycin with those of oral amoxicillin/clavulanic acid in the outpatient treatment of acute recurrent GABHS pharyngotonsillitis.

METHODS

This was an international, multicenter, randomized, investigator-blinded, prospective study in patients with acute recurrent pharyngotonsillitis. Recurrence was defined as > or =2 episodes of documented pharyngeal and/or tonsillar infection within the 12 months before the study. A rapid diagnostic test for GABHS was performed before initiating therapy, and positive results were confirmed by pharyngotonsillar culture. Patients were randomly assigned to receive oral clindamycin 300 mg BID or oral amoxicillin/clavulanic acid 1 g BID for 10 days. Culture was repeated on day 12. The primary study end points were clinical and bacteriologic efficacy assessed on day 12, and clinical and bacteriologic recurrence rates assessed at a visit taking place up to 3 months after the completion of treatment. Tolerability was the secondary end point.

RESULTS

Seven hundred seventy-four patients with acute, recurrent GABHS pharyngotonsillitis were enrolled in the study (mean age, 28 years; age range, 12-60 years). Five hundred forty-two patients (272 clindamycin, 270 amoxicillin/clavulanic acid) were clinically evaluable at day 12. Four hundred ninety-four patients were bacteriologically evaluable, and the safety population included 772 patients. There were no significant differences between groups at baseline. In terms of clinical efficacy at day 12, 252/272 (92.6%) patients in the clindamycin group and 230/270 (85.2%) patients in the amoxicillin/clavulanic acid group were considered cured (P < 0.003). At day 12, bacteriologic eradication was achieved in 237/242 (97.9%) and 238/252 (94.4%) patients in the respective treatment groups (P = NS). No clinical response was observed in the absence of bacteriologic eradication. At 3-month follow-up, clinical cure was achieved in 267/280 (95.4%) patients in the clindamycin group and 267/280 (95.7%) patients in the amoxicillin/clavulanic acid group (P = NS); bacteriologic eradication was observed in 235 (99.2%) and 237 (99.6%) of the respective treatment groups (P = NS). Both treatments were well tolerated. Adverse events were reported in 53/384 (13.8%) patients in the clindamycin group and 41/390 (10.5%) patients in the amoxicillin/clavulanic acid group. The most commonly reported adverse events involved the digestive system (mainly diarrhea), occurring in 33 (8.6%) and 22 (5.6%) patients in the respective treatment groups.

CONCLUSIONS

In this study in patients with acute recurrent GABHS pharyngotonsillitis, oral clindamycin 300 mg BID and oral amoxicillin/clavulanic acid 1 g BID achieved comparable rates of bacteriologic eradication at 12 days and 3 months and comparable clinical cure rates at 3 months. Patients who received clindamycin had significantly greater clinical cure rates at 12 days. Both regimens were well tolerated.

Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection

CONTEXT

Animal model studies have demonstrated the failure of penicillin to cure Streptococcus pyogenes myositis and have suggested that clindamycin is a more effective treatment.

OBJECTIVE

To determine the most effective antibiotic treatment for invasive S. pyogenes infection in humans.

DESIGN AND SETTING

We conducted a retrospective review of the outcomes of all inpatients from 1983 to 1997 treated for invasive S. pyogenes infection at Children's Hospital.

PATIENTS

Fifty-six children were included, 37 with initially superficial disease and 19 with deep or multiple tissue infections.

MAIN OUTCOME MEASURE

Lack of progression of disease (or improvement) after at least 24 h of treatment.

RESULTS

The median number of antibiotic exposures was 3 per patient (range 1 to 6) with clindamycin predominating in 39 of 45 courses of protein synthesis-inhibiting antibiotics and beta-lactams predominating amongst the cell wall-inhibiting antibiotics in 123 of 126 of the remainder. Clindamycin was often used in combination with a beta-lactam antibiotic. Overall there was a 68% failure rate of cell wall-inhibiting antibiotics when used alone. Patients with deep infection were more likely to have a favorable outcome if initial treatment included a protein synthesis-inhibiting antibiotic as compared with exclusive treatment with cell wall-inhibiting antibiotics (83% vs. 14%, P = 0.006) with a similar trend in those with superficial disease (83% vs. 48%, P = 0.07). For those children initially treated with cell wall-inhibiting antibiotics alone, surgical drainage or debridement increased the probability of favorable outcome in patients with superficial disease (100% vs. 41%, P = 0.04) with a similar trend in a smaller number of deep infections (100% vs. 0%, P = 0.14).

CONCLUSIONS

This retrospective study suggests that clindamycin in combination with a beta-lactam antibiotic (with surgery if indicated) might be the most effective treatment for invasive S. pyogenes infection.