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.
“In my own practice, given the results of our analysis, I find it very difficult not to prescribe cephalosporin drugs to my patients,” Casey says. “I am hopeful that organizations such as the American Academy of Pediatrics will review our study and revisit the guidelines.” Physicians involved with the meta-analysis approached their work cautiously, realizing that some analyses are more worthwhile than others. “If such a study is done improperly or without due care, the downside is that faulty data from previous studies will make it into the new one,” Casey says. “But we employed a well-known system of identifying high-quality studies – the Jadad Score – to ensure that we were working only with high-quality data.
“We really turned these 35 studies inside out, comparing and contrasting dozens of different variables,” Casey says. “For instance, we examined factors such as compliance monitoring, which ensures that a child actually took the prescribed drug. Somestudies we reviewed took compliance into consideration, and some did not. When using the data from only studies in which the children were compliant in using the antibiotics, our findings were the same – cephalosporin drugs are more effective.”
Michael Pichichero, M.D., a pediatrician from the University of Rochester Medical Center, served as second author on the study. He and Casey are full-time pediatricians at Elmwood Pediatrics in Rochester, N.Y. The study was not funded by an outside source.