Medicine Science l Med-Science

International Medical Journal – ISSN : 2147-0634

Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis

Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis [English]
Amira S Ahmed, Engy A Wahsh, Essam Eldin G. Ahmed
Med-Science. 2015; 4(2): 2128-42
» Abstract & References » PDF Fulltext» doi: 10.5455/medscience.2015.04.8224

Abstract
Pediatric recurrent pharyngitis represents a huge global health burden causing much morbidity and mortality in children. The aim of the study was to compare the efficacy of oral daily amoxicillin, intramuscular penicillin, and tonsillectomy in reducing the incidence of recurrent pharyngitis Between July 2012 and June 2013, a total of 100 paediatric patients (56 males and 44 females) diagnosed with recurrent pharyngitis were enrolled in the study. The clinical criterion for study entry was three or more episodes of pharyngitis in six months. The selected patients’ clinical data were recorded and a throat swab was obtained. Patients were divided randomly into three groups A, B, and C. Group A received a monthly ten days course of oral amoxicillin suspension (25mg/kg/day) for six months, group B received a single dose of intramuscular benzathine penicillin G every 3 weeks for 6 months and group C included patients who undergo tonsillectomy. All patients were scheduled for a monthly follow-up visit, during which they the number of recurrent pharyngitis episodes, compliance, adverse events and drug tolerability were assessed. All treatment regimens significantly decreased recurrences. While oral amoxicillin and IM penicillin efficacy were comparable, tonsillectomy was similarly effective to IM penicillin treatment and more effective than oral amoxicillin therapy. The once daily oral amoxicillin is a safe, effective and convenient alternative to IM penicillin in reducing the incidence of recurrent pharyngitis. Tonsillectomy is also a suitable alternative, however its possible related morbidity and mortality should be considered.

Key words: Recurrent pharyngitis, prevention, amoxicillin, intramuscular benzathine penicillin G

REFERENCES
1. Koskenkorva T, Koivunen P, Koskela M, Niemela O, Kristo A, Alho OP. Short-term outcomes of tonsillectomy in adult patients with recurrent pharyngitis: a randomized controlled trial. CMAJ. 2013;185(8):331-6. [DOI via Crossref]    [Pubmed]    [PMC Free Fulltext]
2. Sarrell EM, Giveon SM. Streptococcal pharyngitis: a prospective study of compliance and complications. ISRN Pediatrics. 2012;2012:796389.
3. Pfoh E, Wessels M, Goldmann D, Lee G. Burden and economic cost of group A streptococcal pharyngitis. Pediatrics. 2008;121:229-34. [DOI via Crossref]    [Pubmed]
4. Manyemba J and BMM. Intramuscular penicillin is more effective than oral penicillin in secondary prevention of rheumatic fever–a systematic review. SAMJ. 2003;93(3):212�8.
5. Wessels MR. Streptococcal pharyngitis. NEJM. 2011;364(7):648-55. [DOI via Crossref]    [Pubmed]
6. Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008;86(5):408-16. [DOI via Crossref]    [Pubmed]    [PMC Free Fulltext]
7. Wardlaw T, Salama P, Johansson E, Mason E. Pneumonia:the leading killer of children,. Lancet. 2006;368:1048-50. [DOI via Crossref]
8. Kowalska M, Kowalska H, Zawadzka-Glos L, Debska M, Szersszen E, Chmielik M, WÄ…sik M. Dysfunction of peripheral blood granulocyte oxidative metabolism in children with recurrent upper respiratory tract infections. Int J Pediatr Otorhinolaryngol. 2003;67:365-71. [DOI via Crossref]
9. Angelo S, Massimo D, Barbara C, Francesco, Luca G, Barbara J, Renzo M. Sulphurous water inhalations in the prophylaxis of recurrent upper respiratory tract infections. Int J Pediatr Otorhinolaryngol. 2008;72:1717-22. [DOI via Crossref]    [Pubmed]
10. Klug T, Henriksen J, Fuursted K, Ovesen T. Similar recovery rates of fusobacterium necrophorum from recurrently infected and non-infected tonsils. Dan Med Bull. 2011;58:A4295. [Pubmed]
11. Gul M, Okur E, Ciragil P, Yildirim I, Aral M, Kilic MA. The comparison of tonsillar surface and core cultures in recurrent tonsillitis. Am J Otolaryngol. 2007;28:173-6. [DOI via Crossref]    [Pubmed]
12. Stjernquist-Desatnik A, Prellner K, Schalen C. Colonization by Haemophilus influenzae and group A streptococci in recurrent acute tonsillitis and in tonsillar hypertrophy. Am J Otolaryngol. 1990;109:314-31. [DOI via Crossref]
13. Benedict F, Massell M, Larry M. Prevention of rheumatic fever. JAMA. 1972;221(4):410-11. [DOI via Crossref]
14. Gerber MA., Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST, Taubert A. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease. Circulation. 2009;119(11):1541-51. [DOI via Crossref]    [Pubmed]
15. Mahakit P, Vicente JG, Butt DI, Angeli G, Bansal S, Zambrano D. 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 beta-hemolytic streptococci: an international multicenter randomized investigator-blinded, prospective trial in patients between the ages of 12 and 60 years. Clin Ther. 2006;28(1):99-109. [DOI via Crossref]    [Pubmed]
16. Diaz, MC, Symons N, Ramundo ML, Christopher NC. Effect of a standardized pharyngitis treatment protocol on use of antibiotics in a pediatric emergency department. Arch Pediatr Adolesc Med. 2004;158(10):977-81. [DOI via Crossref]    [Pubmed]
17. Gerber MA. Diagnosis and treatment of pharyngitis in children. Pediatr Clin North Am. 2005;52(3):729-4. [DOI via Crossref]    [Pubmed]
18. Armengol CE, Hendley JO. Occurrence of group A beta-hemolytic streptococcal pharyngitis in the four months after treatment of an index episode with amoxicillin once-daily or twice-daily or with cephalexin. Pediatr Infect Dis J. 2012;31(11):1124-7. [DOI via Crossref]    [Pubmed]
19. Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL. Clinical practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. 2012 update by the Infectious Disease Society of America; 2012. Clin Infect Dis. 2012;55(10):e86�102.
20. Schwartz B, Marcy M, Phillips W, Gerber M, Dowell S. Pharyngitis principles of judicious use of antimicrobial agents. Pediatrics. 1998;101:171-4.
21. Van Driel ML, De Sutter IM, Keber N, Habraken H, Christiaens T. Different antibiotics treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2013;4 :1-73. [DOI via Crossref]
22. Robertson K, Volmink J, Mayosi B. Antibiotics for the primary prevention of acute rheumatic fever: a meta- analysis. BMC Cardiovasc Disord. 2005;5(1):11. [DOI via Crossref]    [Pubmed]    [PMC Free Fulltext]
23. Baltimore R. Re-evaluation of antibiotic treatment of strep- tococcal pharyngitis. Curr Opin Pediatr. 2010;22:77�82.
24. Gerber MA and RRT. New approaches to the treatment of group A streptococcal pharyngitis. Curr Opin Pediatr. 2001;13(1):51-5. [DOI via Crossref]    [Pubmed]
25. Shvartzman P, Tabenkin H, Rosentzwaig A, Dolginov F. Treatment of streptococcal pharyngitis with amoxycillin once a day. BMJ. 1993;306:1170-2. [DOI via Crossref]    [Pubmed]    [PMC Free Fulltext]
26. Feder HMJ, Gerber MA, Randolph MF, Stelmach PS, Kaplan EL. Once-daily therapy for streptococcal pharyngitis with amoxicillin. Paediatrics. 1999;103:47-51. [DOI via Crossref]
27. Clegg HW, Ryan AG, Dallas SD, Al. E. Treatment of streptococcal pharyngitis with once-daily compared with twice-daily amoxicillin: a noninferiority trial. Pediatr Infect Dis J. 2006;25:761�7.
28. Lennon DR, Farrell E, Martin DR, Stewart JM. Once‐daily amoxicillin versus twice‐daily Penicillin V in group a {beta}‐ hemolytic Streprococcus pharyngitis. Arch Dis Child. 2008;93(6):474‐8. [DOI via Crossref]    [Pubmed]
29. Baugh RF, Archer SM, Mitchell RB, Richard MR, Amin R, Burns JJ, David H. Clinical practice guideline: tonsillectomy in children. Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2011;144(1):1�30. http://www.ncbi.nlm.nih.gov/pubmed/21493257. abstract access date 11.08.2013.
30. Burton MJ, Glasziou PP. Tonsillectomy or adeno-tonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev. 2009;1. [DOI via Crossref]
31. Mora R, Salami A, Mora F, Cordone MP, Ottoboni S, Passali G.C, Barbieri M. Efficacy of cefpodoxime in the prophylaxis of recurrent pharyngotonsillitis. Int J Pediatr Otorhinolaryngol. 2003;67(1):225-8. [DOI via Crossref]
32. Khan I, Ahmad S, Chawala JA. Original article comparison of FNA vs surface swab culture in isolating core flora in recurrent tonsillitis. J Ayub Med Coll Abbottabad. 2012;24:157-8. [Pubmed]
33. Zautner AE, Krause M, Stropahl G, Holtfreter S, Frickman H, Maletzki C, Kreikemeyer B, Pau H.W, Podbielski A. Intracellular persisting Staphylococcus aureus is the major pathogen in recurrent tonsillitis. journal of public library of science one. 2010;5(3):e9452.
34. Schaad UB. OM-85 BV, an immunostimulant in pediatric recurrent respiratory tract infections: a systematic review. World J Pediatr.2010;6:5�12.
35. David J, Rosen F. Deficiencies in immunoglobulins and cell- mediated immunity (CDRom). Chapter IX, Scientific Am Med ,New York, US, SAM-CD.; 2000.
36. Pickering LK, Granoff DM, Erickson, JR, Masor ML, Cordle CT, Schaller JP , Winship TR, Paule CL, Hilty DM. Modulation ofthe immune system by human milk and infant formula containing nucleotides. Pediatrics. 1998;101:242-9. [DOI via Crossref]    [Pubmed]
37. Stuebe A. The risks of not breastfeeding for mothers and infants. Reviews in obstetrics and gynecology. 2009;2(4):222-31. [Pubmed]    [PMC Free Fulltext]
38. Rober M, Bass J, Michels G. Streptococcal pharyngitis: placebocon rolled double blind evaluation of clinical response to penicillin therapy. JAMA . 1985;253:1271�74.
39. Randolph MF, Gerber MA, DeMeo KK, Wright L. Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis. J Pediatr. 1985;106:870�5.
40. Catanzaro FJ, Stetson CA, Morris, AJ, Chamov�tz R, Rammelkamp CH Jr, Stolzer BL, Perry WD. The role of the streptococcus in the pathogenesis of rheumatic fever. Am J Med. 1954;17:749�56.
41. Sirimanna KS, Madden GJ, Miles SM. The use of long-acting penicillin in the prophylaxis of recurrent tonsillitis. J Otolaryngol. 1990;19(5):343�344.
42. Del Mar C, Glasziou P, Spinks A. Antibiotics for sore throat. Cochrane Database Syst Rev. 2006;4:CD000023. [Pubmed]
43. Manyemba J, Mayosi BM. Intramuscular penicillin is more effective than oral penicillin in secondary prevention of rheumatic fever–a systematic review. SAMJ 2003;93(3):212�8.
44. Feinstein AR, Wood HF, Epste�n JA, Taranta A, S�mpson R, Tursky E. Acontrolled study of three methods of prophylaxis against streptococcal infection in a population of rheumatic children. NEJM. 1959;260:697�701.
45. Feinstein A, Spagnuolo M, Jonas S, Kloth H, Tursky E, Levitt M. Prophylaxis of recurrentrheumatic fever. Therapeutic-continuous oral penicillin vs monthly injections. JAMA. 1968;206:565�8.
46. Feinstein A. Prophylaxis of recurrent rheumatic fever. Ineffectiveness of intermittent therapeutic oral penicillin. JAMA. 1965;191:451�4.
47. Phair J, Carleston J, Weihl C. Penicillin phenoxymethyl. Use in rheumatic fever prophylaxis. Am J of Diseases of Children. 1973;126:48�50.
48. Cohen, R, Levy C, Dolit C, De La Rocque F, Boucherat M, Fitoussi F, Language J, Bingen E. Six-day amoxicillin vs. ten-day penicillin V therapy for group A streptococcal tonsillopharyngitis. Pediatr Infect Dis J. 1996;15(8):678�82.
49. Rimoin AW, Hoff NA, Walker CLF, Hamza H.S, Vince A, Rahman N.A, Andrasevic S, Emam S, Vukelic D, Elminawi N, Ghafar H.A, da Cunga ALA, Qazi S, Gardovska D, Steinhoff M.C Treatment of Streptococcal Pharyngitis With Once-Daily Amoxicillin Versus Intramuscular Benzathine Penicillin G in Low-Resource Settings: A Randomized Controlled Trial. Clin Pediatr. 2011;50(6):535 �42.
50. Martin J, Burton and PPG. �Tonsillectomy or adenotonsillectomy versus non-surgicaltreatment for chronic/recurrent acute tonsillitis (Review).� Cochrane Database Syst Rev. 2009;1:1�34.
51. Koskenkorva T, Koivunen P, Koskela M, Niemela O, Kristo A, Alho O-P. Short-term outcomes of tonsillectomy in adult patients.CMAJ. 2013;185(8):331�6.
52. Burton MJ, Towler B GP. Tonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev. 2000;2:CD001802. [Pubmed]
53. Feinstein A, Levitt M. The role of tonsils in predisposing to streptococcal infections and recurrences of rheumatic fever. N Engl J Med. 1970;282:5�91.
54. Blakley BW, Magit AE. The role of tonsillectomy in reducing recurrent pharyngitis. Otolaryngol Head Neck Surg. 2009;140:291�7.
55. Alho OP, Koivunen P, Penna T, Teppo H, Koskela M, Luotonen J. Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial. BMJ. 2007:334:939. [DOI via Crossref]    [Pubmed]    [PMC Free Fulltext]
56. Report of the Committee on Infectious Disease. Group A Streptococcal infections. In: Pickering L, ed. IL: AAP . 29th Editi. Elk Grove Village. 2012:668�80.
57. Dajani A, Taubert K, Ferrieri P, Peter G, Shulman S. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Hear. Pediatrics. 1995;96:758� 64.
58. Lieu T, Fleisher G, Schwartz J. Cost-effectiveness of rapid latex agglutination testing and throat culture for streptococcal pharyngitis. Pediatrics. 1990;85:246�56.
59. Webb K. Does culture confirmation of high-sensitivity rapid streptococcal tests make sense? A medical decision analysis. Pediatrics. 1998;101:E2. [DOI via Crossref]
60. Irlam, J, Mayosi BM, Engel M, Gaziano TA. Primary prevention of acute rheumatic fever and rheumatic heart disease with penicillin in South African children with pharyngitis: a cost effectiveness analysis. Circ Cardiovasc Qual Outcome. 2013;6(3):343-51. [DOI via Crossref]    [Pubmed]

How to Cite this Article
Pubmed StyleAhmed AS, Wahsh EA, Ahmed EEG. Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis. Med-Science. 2015; 4(2): 2128-42. doi:10.5455/medscience.2015.04.8224


Web StyleAhmed AS, Wahsh EA, Ahmed EEG. Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis. www.scopemed.org/?mno=170455 [Access: July 28, 2015].doi:10.5455/medscience.2015.04.8224


AMA (American Medical Association) StyleAhmed AS, Wahsh EA, Ahmed EEG. Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis. Med-Science. 2015; 4(2): 2128-42. doi:10.5455/medscience.2015.04.8224


Vancouver/ICMJE StyleAhmed AS, Wahsh EA, Ahmed EEG. Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis. Med-Science. (2015), [cited July 28, 2015]; 4(2): 2128-42.doi:10.5455/medscience.2015.04.8224


Harvard StyleAhmed, A. S., Wahsh, E. A. & Ahmed, E. E. G. (2015) Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis. Med-Science, 4 (2), 2128-42.doi:10.5455/medscience.2015.04.8224


Turabian StyleAhmed, Amira S, Engy A Wahsh, and Essam Eldin G. Ahmed. 2015. Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis. Medicine Science | International Medical Journal, 4 (2), 2128-42. doi:10.5455/medscience.2015.04.8224


Chicago StyleAhmed, Amira S, Engy A Wahsh, and Essam Eldin G. Ahmed. “Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis.” Medicine Science | International Medical Journal 4 (2015), 2128-42. doi:10.5455/medscience.2015.04.8224


MLA (The Modern Language Association) StyleAhmed, Amira S, Engy A Wahsh, and Essam Eldin G. Ahmed. “Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis.” Medicine Science | International Medical Journal4.2 (2015), 2128-42. Print. doi:10.5455/medscience.2015.04.8224


APA (American Psychological Association) StyleAhmed, A. S., Wahsh, E. A. & Ahmed, E. E. G. (2015) Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis. Medicine Science | International Medical Journal, 4 (2), 2128-42.doi:10.5455/medscience.2015.04.8224

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