Clinical Studies| Volume 20, ISSUE 1, P72-79, January 1998

Clinical comparison of cefaclor twice daily versus amoxicillin-clavulanate or erythromycin three times daily in the treatment of patients with streptococcal pharyngitis

      This paper is only available as a PDF. To read, Please Download here.


      The present study was undertaken to compare the efficacy and safety of a new regimen of cefaclor (25 mg/kg BID) with amoxicillin-clavulanate and erythromycin TID at standard doses for the treatment of pediatric patients with acute pharyngotonsillitis (APT). A total of 673 children (age range, 2 to 12 years) with signs and symptoms of APT were enrolled; 245 of these children who had a positive throat culture for group A beta-hemolytic streptococci (GABHS) entered the study and were randomly assigned to receive cefaclor 25 mg/kg BID, amoxicillin-clavulanate 15 mg/kg TID, or erythromycin 15 mg/kg TID. A 10-day antibiotic course was prescribed for each patient. Clinical and bacteriologic responses were assessed at the end of treatment (day 10) and at the follow-up visit (day 30). All GABHS strains isolated from throat cultures were tested for in vitro sensitivity to the antibiotics used in the study. Side effects (mainly nausea) were rare and mild in each group and did not require discontinuation of therapy. No GABHS strain was resistant to cefaclor or to amoxicillin-clavulanate; 37.9% of the strains were resistant to erythromycin. The results indicated that cefaclor given BID seems to be as effective as amoxicillin-clavulanate given TID (cure rate, 91.9% and 90.5%, respectively) and more effective than erythromycin given TID (cure rate, 76.8%) for the treatment of patients with APT. Erythromycin resistance among GABHS is an emerging problem in many geographic areas.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hoekelman RA
        • Starfield B
        • McCormick M
        • et al.
        A profile of pediatric practice in the United States.
        Am J Dis Child. 1983; 137: 1057-1060
        • Putto A
        Febrile exudative tonsillitis: Viral or streptococcal.
        Pediatrics. 1987; 10: 6-12
        • Brook I
        Role of beta-lactamase producing bacteria in the failure of penicillin to eradicate group A streptococci.
        Pediatr Infect Dis J. 1985; 4: 491-495
        • Roos K
        • Grahn E
        • Holm SE
        Evaluation of beta-lactamase activity and microbial interference in treatment failures of acute streptococcal tonsillitis.
        Scand J Infect Dis. 1986; 18: 313-319
        • Stillerman M
        Comparison of oral cephalosporins with penicillin therapy for group A streptococcal pharyngitis.
        Pediatr Infect Dis J. 1986; 5: 649-654
        • Bass JW
        Antibiotic management of group A streptococcal pharyngo-tonsillitis.
        Pediatr Infect Dis J. 1991; 10 (Suppl 10): s43-s49
        • Pichichero ME
        • Margolis PA
        A comparison of cephalosporins and penicillins in the treatment of group A beta-hemolytic streptococcal pharyngitis: A meta-analysis supporting the concept of microbial copathogenicity.
        Pediatr Infect Dis J. 1991; 10: 275-281
        • National Committee for Control Laboratory Standards
        5th ed. Performance Standards for Antimicrobial Disk Susceptibility Tests. NCCLS, Villanova, PA1995
        • Walsh BT
        • Bookheim WW
        • Johnson RC
        • et al.
        Recognition of streptococcal pharyngitis in adults.
        Arch Intern Med. 1975; 135: 1493-1497
        • Breese BB
        A simple score card for the tentative diagnosis of streptococcal pharyngitis.
        Am J Dis Child. 1977; 131: 514-517
        • Centor RM
        • Meier FA
        • Dalton HP
        Throat culture and rapid test for rapid diagnosis of group A streptococcal pharyngitis.
        Ann Intern Med. 1986; 105: 892-899
        • Komaroff AL
        • Pass TM
        • Aronson MD
        • et al.
        The prediction of streptococcal pharyngitis in adults.
        J Intern Med. 1986; 1: 1-7
        • Poses RM
        • Cebul RD
        • Collins M
        • Fager SS
        The accuracy of experienced physicians' probability estimates for patients with sore throats.
        JAMA. 1985; 254: 925-929
        • Moffet HL
        • Siegel AC
        • Doyle HK
        Nonstreptococcal pharyngitis.
        J Pediatr. 1968; 73: 51-60
        • Pechere JC
        Cost-benefit of throat swab in pharyngitis.
        Med Hygiene. 1996; 54: 1901-1905
        • Gastanaduy AS
        • Howe BB
        • Kaplan AL
        • et al.
        Failure of penicillin to eradicate group A streptococci during an outbreak of pharyngitis.
        Lancet. 1980; i: 498-501
        • Howie VM
        • Ploussard JH
        Treatment of group A streptococcal pharyngitis in children.
        Am J Dis Child. 1971; 121: 477-480
        • Pichichero ME
        • Disney FA
        • Aronovitz GH
        • et al.
        Randomized, single-blind evaluation of cefadroxil and phenoxymethyl penicillin in the treatment of streptococcal pharyngitis.
        Antimicrob Agents Chemother. 1987; 31: 903-906
        • Feldman S
        • Bisno AL
        • Lott L
        • et al.
        Efficacy of benzathin penicillin G in group A streptococcal pharyngitis: Reevaluation.
        J Pediatr. 1987; 110: 783-787
        • Kim KS
        • Kaplan EL
        Association of penicillin tolerance with failure to eradicate group A streptococci from patients with pharyngitis.
        J Pediatr. 1985; 107: 681-684
        • Smith TD
        • Huskins WC
        • Kaplan EL
        Efficacy of beta-lactamase resistant penicillin and influence of penicillin tolerance in eradicating streptococci from the pharynx after failure of penicillin therapy for group A streptococcal pharyngitis.
        J Pediatr. 1987; 110: 777-782
        • Dajani AS
        • Bisno AL
        • Chung KJ
        • et al.
        Prevention of rheumatic fever. A statement for health professionals by the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, The American Heart Association.
        Circulation. 1986; 78: 1082-1086
        • American Academy of Pediatrics
        Group A streptococcal infections.
        in: Peter E 22nd ed. Report of the Committee on Infectious Diseases. American Academy of Pediatrics, Elk Grove Village, Ill1991: 438-447
        • Ginsburg CM
        • McCracken GH
        • Crow SD
        • et al.
        Erythromycin therapy for group A streptococcal pharyngitis.
        Am J Dis Child. 1984; 138: 536-539
        • Milatovic D
        Evaluation of cefadroxil, penicillin and erythromycin in the treatment of streptococcal pharyngo-tonsillitis.
        Pediatr Infect Dis J. 1991; 10 (Suppl): S61-S63
        • Camporese A
        • Tizianel G
        • Santalena G
        Osservatorio epidemiologico sulle resistenze di Streptococcus pyogenes a macrolidi e lincosamidi.
        Infezioni Med. 1996; 2: 74-78
        • Zanacca C
        • Boschi G
        • Menozzi MC
        • et al.
        Impiego del cefaclor nella faringite streptococcica.
        Presented at Convegno Nazionale di Antibioticoterapia in età Pediatrica. 15161990; (Milan, Italy)
      1. Dillon HC, Disney FA, McLinn SE, et al. A multiclinic study for the evaluation of cefaclor TID and BID dosage regimens in the treatment of bacterial pharyngitis. Protocol 83. Data on file, Eli Lilly, Indianapolis, Indiana.