Cochrane · systematic review · CD004406

Different antibiotic treatments for group A streptococcal pharyngitis

Hedin, K, Thorning, S, van Driel, ML · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library

Acute Respiratory Infections3 versionsAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
17
current version
GRADE rated
17
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 7 · 41.2%Low 10 · 58.8%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Questions and results

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Cephalosporins versus penicillin for group A streptococcal pharyngitis

Population: group A streptococcal pharyngitis
4 questions
OutcomeEffectEvidenceStatus / GRADE
Resolution of symptoms post‐treatment (ITT analysis)
Cephalosporins vs penicillin
OR 0.79 [0.55, 1.12]5 studies · 2018 participantsLow
Downgraded: risk of bias, imprecision
Resolution of symptoms post‐treatment (evaluable participants)
Cephalosporins vs penicillin
OR 0.51 [0.27, 0.97]5 studies · 1660 participantsVery low
Downgraded: risk of bias, imprecision, inconsistency
Incidence of relapse (evaluable participants)
Cephalosporins vs penicillin
OR 0.55 [0.3, 0.99]4 studies · 1386 participantsLow
Downgraded: risk of bias, imprecision
Adverse events (ITT analysis)
Cephalosporins vs penicillin
OR 0.94 [0.27, 3.25]3 studies · 1279 participantsVery low
Downgraded: risk of bias, imprecision, inconsistency

Macrolides versus penicillin for group A streptococcal pharyngitis

Population: group A streptococcal pharyngitis
4 questions
OutcomeEffectEvidenceStatus / GRADE
Resolution of symptoms post‐treatment (ITT analysis)
Macrolides vs penicillin
OR 1.11 [0.92, 1.35]6 studies · 1728 participantsLow
Downgraded: imprecision
Resolution of symptoms post‐treatment (evaluable participants)
Macrolides vs penicillin
OR 0.79 [0.57, 1.09]6 studies · 1159 participantsLow
Downgraded: imprecision
Incidence of relapse (evaluable participants)
Macrolides vs penicillin
OR 1.21 [0.48, 3.03]6 studies · 802 participantsLow
Downgraded: imprecision
Adverse events (ITT analysis)
Macrolides vs penicillin
OR 1.19 [0.82, 1.73]6 studies · 1727 participantsLow
Downgraded: imprecision

Azithromycin versus amoxicillin for group A streptococcal pharyngitis

Population: group A streptococcal pharyngitis
5 questions
OutcomeEffectEvidenceStatus / GRADE
Clinical cure (ITT analysis)
Azithromycin vs amoxicillin
OR 0.76 [0.55, 1.05]1 study · 673 participantsVery low
Downgraded: imprecision
Clinical cure (bacteriological per protocol analysis)
Azithromycin vs amoxicillin
OR 0.29 [0.11, 0.73]1 study · 482 participantsVery low
Downgraded: imprecision
Relapse (ITT analysis)
Azithromycin vs amoxicillin
OR 0.75 [0.55, 1.02]1 study · 673 participantsVery low
Downgraded: imprecision
Relapse (bacteriological per protocol analysis)
Azithromycin vs amoxicillin
OR 0.88 [0.43, 1.82]1 study · 422 participantsVery low
Downgraded: imprecision
Adverse events (ITT analysis)
Azithromycin vs amoxicillin
OR 2.67 [1.78, 3.99]1 study · 673 participantsVery low
Downgraded: imprecision

Carbacephem versus penicillin for group A streptococcal pharyngitis

Population: group A streptococcal pharyngitis
4 questions
OutcomeEffectEvidenceStatus / GRADE
Resolution of symptoms post‐treatment (ITT analysis)
Carbacephem vs penicillin
OR 0.7 [0.49, 0.99]3 studies · 795 participantsLow
Downgraded: imprecision
Resolution of symptoms post‐treatment (evaluable participants)
Carbacephem vs penicillin
OR 0.62 [0.38, 1.01]3 studies · 602 participantsLow
Downgraded: imprecision
Incidence of relapse (evaluable participants)
Carbacephem vs penicillin
OR 1.27 [0.64, 2.5]3 studies · 523 participantsLow
Downgraded: imprecision
Adverse events (ITT analysis)
Carbacephem vs penicillin
OR 1.08 [0.75, 1.55]3 studies · 795 participantsLow
Downgraded: imprecision