Introduction

Tonsillitis is the most common upper respiratory infection disease in children, mainly caused by Group A ?-hemolytic streptococcus (GAS)infection. Azithromycin is a type of macrolide antibiotic and used for the treatment of varieties of bacterial infections, including pharyngitis and tonsillitis.

Aim

To evaluate and compare the clinical efficacy of azithromycin (10 mg/kg per day once daily for 3 days) or cefaclor (20 mg/kg per day in 3 divided doses for 5 days)

with amoxicillin (30 mg/kg per day in 3 divided doses for 10 days), for the treatment of tonsillitis in children.

Patient Population

• N=256 children
• aged between 2 and 12 years
• signs and symptoms of tonsillitis
• The children were diagnosed with tonsillitis by the presence of a sore throat and (or) a swollen, hyperemic, or suppurated tonsil and (or) visible secretions or erythema of tonsil and (or) with fever

Methods

• Each patient was scheduled for the follow-up for the clinical and bacteriologic assessment on day 14 and day 30 from the start of the treatment
  • The signs and symptoms were observed, and the tonsils swab cultures were conducted for the bacteriological examination
  • Blood sample and urinalysis were performed to determine the safety and the complication of the drug for the patients
• Clinical and Bacteriological assessments were conducted
  • The therapeutic efficacy was evaluated as success or failure on day 14 from the start of the treatment according to the clinical symptoms
  • The clinical success was defined by the improvement of signs and symptoms and the disappearance of fever, such that no additional drugs were needed for the therapy
  • The therapy failure was defined by the lack of improvement in clinical symptoms, which needed additional antibiotic therapy
  • The first bacteriologic outcome was defined as eradication or failure by a pharyngeal/tonsil swab culture on day 14, soon after completion of therapy
  • The success of microbiologic evaluation was defined by the eradication of the pathogen identified by a pharyngeal/tonsil swab culture
  • The secondary microbiologic outcome was evaluated on day 30 among patients designated microbiologic successes on day 14 and with the follow-up at day 30, which was classified as eradication and recurrence (the reappearance of the pathogen

Results

^aStudent’s t-test.

^b x² test.

Clinical Efficacy and Microbiologic Outcome

• At the end of therapy (day 14) and microbiologic results at follow-up (day 30)
• There was no statistical difference, but a tendency toward more chance of therapeutic improvement in patients treated with azithromycin in comparison with those treated with cefaclor and amoxicillin was observed

^aFisher’s exact test.

^bx² test.

 Safety

• The adverse events occurrence rate in the azithromycin treatment group was lower than those in the other 2 groups (p = 0.030 and p = 0.029)
• No significant difference was observed between cefaclor and amoxicillin groups (p = 0.977)
• Azithromycin treatment showed lower occurrence rate of adverse events than the other 2 groups

^aFisher’s exact test

^b X² test

Conclusion

• The study demonstrated that azithromycin showed a better tendency of clinical efficacy and microbiologic outcome with lower recurrence of bacteria and less adverse events compared with the other 2 groups

•  The three groups showed no statistical difference for the clinical effectiveness and bacterial elimination, however, there was a tendency that azithromycin treatment is more effective than the cefaclor and amoxicillin treatments with a lower occurrence rate of adverse reactions

• The findings indicated 3-day treatment with azithromycin (10 mg/kg per day once daily) is a promising alternative for therapy of tonsillitis in children caused by GAS

Reference

Can J Physiol Pharmacol.2019;97(10):939-944