Multicenter comparative trial of cefixime and phenoxymethylpenicillin for group a beta-hemolytic streptococcal tonsillitis

This multicenter, open, comparative study compared the efficacy and safety of cefixime 200 mg or 4 mg/kg twice daily for 4 days and phenoxymethylpenicillin 1 million IU three times daily for 10 days in the treatment of group A beta-hemolytic streptococcal (GABHS) tonsillitis. Among the 177 patients studied, 93 were randomized to receive cefixime and 84 phenoxymethylpenicillin. The groups were homogeneous. At the end of therapy, GABHS eradication rates were similar in both groups: 94% (63 of 67 patients) in the cefixime group and 96.2% (50 of 52 patients) in the phenoxymethylpenicillin group. At the follow-up visit (4 weeks), recurrence rates were 9.3% and 12.5% in the cefixime and phenoxymethylpenicillin groups, respectively. Symptoms disappeared significantly faster in the cefixime group (fever duration, P = 0.002, and sore throat, P = 0.002). Treatment compliance was significantly better in the cefixime group (P = 0.007, for treatment duration). Safety was identical in both groups. A 4-day course of cefixime appears to be an effective treatment for GABHS tonsillitis.