Feneticilline voor acute keelinfectie bij volwassenen: sneller herstel bij een 7-daagse kuur dan bij een 3-daagse kuur of placebo; een gerandomiseerd dubbelblind onderzoek

To assess whether a 3-day course of phenethicillin (penicillin B) for sore throat patients with regard to the acceleration of clinical recovery and the prevention of recurrences and complications, was as effective as a 7-day course or a placebo.

Design

Randomised and double-blind placebo-controlled.

Method

In the period 1994/'96, 55 general practitioners at 43 surgeries in the Netherlands (Kampen-Zwolle region) treated 561 patients, aged 15-44 years, with sore throat ≤ 7 days and at least 3 of the 4 Centor criteria (history of fever, absence of cough, swollen tender anterior cervical lymph nodes, and (tonsillar) exudates) with 7 days of penicillin B, 3 days of penicillin B followed by 4 days of placebo, or 7 days of placebo. The patients noted their clinical recovery during the first week, The GPs took a throat smear for culturing purposes both before the treatment and two weeks thereafter. Two, four and six months after the treatment, the research assistent contacted the patient by phone to establish whether the sore throat symptoms had recurred and if there were other upper respiratory tract symptoms.

Results

One hundred and ninety patients were treated with penicillin B for 7 days, 194 patients were treated with penicillin B for 3 days and 177 patients were given a placebo. The average age in the 3 groups was 28 years and the percentage of men in each group was 39, 36 and 39 respectively. After a median period of 3.6 days, the sore throat symptoms had permanently disappeared in the 7-day penicillin B group; this was 1.9 days earlier than in the 3-day penicillin B group and 1.7 days earlier than in the placebo group (p < 0.001). Symptoms resolved 2.5 days earlier in patients with group A streptococci (p < 0.001) than in the other 2 treatment groups and 1.5 days (p = 0.03) respectively 1.1 days (p = 0.05) earlier in patients with high colony counts of non-group A streptococci. Twenty-three (13) of the placebo-treated patients were administered antibiotics due to a clinical deterioration and 3 of them developed a peritonsillar abscess. A sore throat recurred more often in the 3-day penicillin B group than in the other treatment groups.

Conclusion

A 7-day, and not a 3-day, penicillin B treatment resulted in a more rapid resolution of the symptoms than a placebo in adult patients with an acute sore throat and (group A) streptococcal pharyngitis.