Pediatricians treating a child who has strep throat should reconsider the role of penicillin given that a newer class of antibiotics called cephalosporins are three times more effective, according to a study being published in the April issue of Pediatrics. The findings will spark widespread debate, because they contradict long-established guidelines from the American Academy of Pediatrics, American Heart Association,and World Health Organization.
Strep throat is a bacterial infection that can be spread by personal contact, including coughing or sneezing, often affecting school-age children. Penicillin is considered the gold standard for treating strep throat, but pediatricians should realize that cephalosporins are more effective in killing the germs, says Janet Casey, M.D., the study’s lead author and a University of Rochester Medical Center pediatrician. Cephalosporin drugs – such as Cephalexin, Cefadroxil, and Cefprozil, Cephdinir – are oral medications that come in liquid and pill forms, and are safe for infants, children, and teens.
The new study presents findings from a meta-analysis, a review of previous studies done about the efficacy of cephalosporin drugs and penicillin. “We carefully examined 35 studies done since 1969, all of which discussed whether cephalosporin or penicillin are more effective in treating strep throat,” Casey says, noting more than 7,000 children participated in the studies. “Children who have strep throat will have a superior outcome if they receive cephalosporin rather than penicillin.” The findings indicate that the newer class of drugs has a more impressive bacterial cure rate.
First-generation cephalosporin drugs, such as Cephalexin and Cefadroxil, are comparable in cost to penicillin, and provide the same narrow-spectrum effect, Casey says. Using a drug that has a narrow spectrum is important because it is targeted enough to cure the bacteria, but not so strong that it causes resistance, which could lead to fostering of a super bug. In fact, one of the reasons penicillin – and its close relative, amoxicillin – remains the recommended course of treatment is because it has a very targeted effect. But, Casey says, so do many cephalosporin drugs. Some penicillin proponents don’t spend much time in the pediatrician’s office, Casey says. “Many of these doctors aren’t in the trenches anymore seeing sick children every day,” she says. “Those of us who are see how frustrating it is for families who need to come back for additional treatments, who wonder why the antibiotic their child took didn’t work.