Abstract
We prospectively compared the efficacy of oral cefditoren-pivoxil and conventional oral amoxicillin for pharyngotonsillitis caused by group A streptococcus in children. Either oral cefditoren-pivoxil (3 mg/kg t.i.d. for 5 days) or amoxicillin (10 mg/kg t.i.d. for 10 days) was administered to patients with group A streptococcal pharyngotonsillitis attending the pediatric outpatient clinic of Showa Hospital (Konan, Japan) between January and December 2006. Diagnosis was based on isolation of bacteria from a pharyngeal swab. Culture was always done to confirm eradication, and urinalysis and follow-up were performed at least once weekly for 4 weeks. Among 258 patients, 103 (aged 5.5 ± 2.3 years) received cefditoren-pivoxil and 155 (aged 5.2 ± 2.0 years) received amoxicillin. There were no significant between-group differences in age, sex, or symptoms. Eradication was confirmed in 99% (102/103) of the cefditoren-pivoxil group and 100% of the amoxicillin group. Recurrence within 4 weeks occurred in 8 and 15 patients in the cefditoren-pivoxil and amoxicillin groups, respectively, showing no significant difference in the recurrence rate, and all isolates had the same serotypes as before. There were no clinically significant adverse reactions or complications. The 50%/90% minimum inhibitory concentrations (μg/ml) of cefditoren-pivoxil and amoxicillin for the 258 isolates were ≤0.03/≤0.03 and ≤0.03/0.06, respectively, so all isolates were susceptible to both agents. Because the efficacy for pediatric group A streptococcus pharyngotonsillitis was similar between oral cefditoren-pivoxil for 5 days and amoxicillin for 10 days, the shorter treatment period may make the former regimen preferable.
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References
Kiselica D. Group A beta-hemolytic streptococcal pharyngitis: current clinical concepts. Am Fam Physician 1994;49:1147–1154.
Schroeder BM. Diagnosis and management of group A streptococcal pharyngitis. Am Fam Physician 2003;67:880–884.
Tamura A, Okamoto R, Yoshida T, Yamamoto H, Kondo S, Inoue M, et al. In vitro and in vivo antibacterial activities of ME1207, a new oral cephalosporin. Antimicrob Agents Chemother 1988;32:1421–1426.
Miyazaki S, Miyazaki Y, Tsuji A, Nishida M, Goto S. In vitro antibacterial activity of ME1207, a new oral cephalosporin. Antimicrob Agents Chemother 1991;35:1691–1694.
Felmingham D, Robbins MJ, Ghosh G, Bhogal H, Mehta MD, Leakey A, et al. An in vitro characterization of cefditoren, a new oral cephalosporin. Drugs Exp Clin Res 1994;20:127–147.
Funahashi K, Nakane K, Ushigaki M, Tanaka K, Nishimura N, Ozaki T. T-serotypes and antimicrobial sensitivity of group A streptococcus isolated from pharyngeal swabs in children with respiratory tract infections. Jpn J Med Technol 2003;52:26–30.
Funahashi K, Nakane K, Shibata Y, Tanaka K, Nishimura N, Ozaki T. A bacteriological study of group A streptococcus strains isolated from children with upper respiratory infection. Jpn J Med Technol 2005;54:1310–1315.
Japanese Society of Pediatric Pulmonology and Japanese Society for Pediatric Infectious Diseases. Guidelines for the management of respiratory infectious diseases in children in Japan 2007. In: Uehara S, Sunagawa K, editors. Tokyo: Kyowakikaku: 2007. p. 31–34.
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: seventeenth informational supplement. 27 (1) (M100-S17). Wayne: CLSI; 2007. p. 130–135.
Leung AKC, Kellner JD. Group A β-hemolytic streptococcal pharyngitis in children. Adv Therapy 2004;21:277–287.
American Academy of Pediatrics. Group A streptococcal infections. In: Pickering LK, Baker CJ, Long SS, McMillan JA, editors. Red Book. 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village: American Academy of Pediatrics; 2006. p. 610–620.
Pichichero M, Casey J. Comparison of European and US results for cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis. Eur J Clin Microbiol Infect Dis 2006;25:354–364.
Kaplan EL, Tucker RM, Poling TL, Marsh D, Chou C. Managing group A streptococcal infection: a multicenter comparison of cefditoren pivoxil and penicillin VK. J Resp Dis 2001;22:S60–S64.
Nakayama E, Sunaoshi K, Suzuki E, Kobayashi R, Momomura M, Funaki N, et al. Clinical efficacy of oral antibiotics in treating pharyngotonsillitis caused by Streptococcus pyogenes: a comparative study of eradication among 6 agents. Jpn J Chemother 2004; 52:426–432.
Ioth M, Kakinuma H, Takahashi H. A patient with hypoglycemic seizures after long-term treatment of antibiotics conjugated with pivarate. Clin Pediatr Endocrinol 2002;11:140.
Teraoka M, Wada T, Ogura K, Yasuhara S, Kitamura T, Murakami N. et al. A patient with hypoglycemia after long-term treatment of antibiotics. J Jpn Pediatr Soc 2004;108:1059–1061.
Fujii R, Chiba S, Numazaki K, Mori T, Terashima I, Meguro H, et al. Effect of cefditoren pivoxil on carnitine metabolism in pediatric patients. Jpn J Antibiot 1993;46:926–937.
Brass EP. Pivalate-generating prodrugs and carnitine homeostasis in man. Pharmacol Rev 2002;54:589–598.
Infectious Disease Surveillance Center, National Institute of Infectious Diseases. Streptococcal infections in Japan, 2000–2004. IASR 2004;25:252′–253′.
Tanaka D, Gyobu Y, Kodama H, Isobe J, Hosorogi S, Hiramoto Y, et al. emm typing of group A streptococcus clinical isolates: identification of dominant types of throat and skin isolates. Microbiol Immunol 2002;46:419–423.
Bozdogan B, Appelbaum PC. Macrolide resistance in streptococci and Haemophilus influenzae. Clin Lab Med 2004;24:455–475.
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Ozaki, T., Nishimura, N., Suzuki, M. et al. Five-day oral cefditoren pivoxil versus 10-day oral amoxicillin for pediatric group A streptococcal pharyngotonsillitis. J Infect Chemother 14, 213–218 (2008). https://doi.org/10.1007/s10156-008-0602-7
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DOI: https://doi.org/10.1007/s10156-008-0602-7