Efficacy of lincomycin versus penicillin and clarithromycin in patients with acute pharyngitis/tonsillitis caused by group a beta-hemolytic streptococci and a clinical history of recurrence

This open-label, prospective, randomized, comparative, single-masked study was performed at eight centers in the Philippines and Latin America (Chile, Colombia, Peru, Brazil, and Venezuela). The purpose of this study was to assess the efficacy and tolerability of three different antibiotic regimens for the treatment of acute pharyngitis/tonsillitis as a result of group A beta-hemolytic streptococci (GABHS), and to assess the rate of recurrences. Children (aged 3 to 15 years) and adults with a recent history of tonsillitis associated with a positive rapid diagnostic test for group A streptococcus, later confirmed by positive cultures for GABHS, were randomized to one of the following antibiotic regimens (according to patient age) for 10 days: (1) lincomycin hydrochloride capsules or suspension: adults—two 500-mg capsules two times a day (BID) for 10 days; children—60 mg/kg per day divided BID for 10 days (maximum dose, 1000 mg/d); (2) phenoxymethylpenicillin capsules or suspension: adults—one 500-mg capsule three times a day (TID) for 10 days; children—50 mg/kg per day divided TID for 10 days (maximum dose, 1500 mg/d); (3) clarithromycin capsules or suspension: adults—one 250-mg capsule BID for 10 days; children—7.5 mg/kg per day divided BID for 10 days (maximum dose, 500 mg/d). After the initiation of treatment (12 to 14 days) and 3 months after completion, patients were evaluated to assess clinical and microbiologic recurrences. Our results indicate that all drugs had statistically similar clinical and bacteriologic efficacy as well as tolerability for the treatment of acute GABHS pharyngitis/tonsillitis with a clinical history of recurrence.