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Br J Gen Pract. 1996 October; 46(411): 589–593.
PMCID: PMC1239783

Do patients with sore throat benefit from penicillin? A randomized double-blind placebo-controlled clinical trial with penicillin V in general practice.


BACKGROUND: The effect of antibiotic therapy in sore throat is questionable and this dilemma has been complicated by the emergence of multiple resistant strains of micro-organisms. AIM: A randomized double-blind placebo-controlled clinical trial was undertaken in patients aged 4-60 years to assess the efficacy of penicillin V on the clinical course and bacteriological response in patients with sore throat in general practice. METHOD: Two hundred and thirty-nine patients presenting with an acute sore throat to 37 general practices in the Netherlands who were clinically suspected of group A beta-haemolytic streptococci (GABHS) were randomized for treatment with penicillin V (n = 121) or placebo (n = 118). Resolution of sore throat, fever and return to daily activities were evaluated by the general practitioner 2 days after the start of treatment and by the patients keeping a diary for 7 days. The result of throat culture after 2 days was evaluated. RESULTS: A difference in resolution of sore throat was present after 2 days in all patients, but was a result of GABHS-positive patients (n = 111; 46%) in favour of those randomized for penicillin V (adjusted odds ratio 5.3; 95% CI 1.9-15.1). An effect in the course of fever was also seen in GABHS-positive patients (adjusted odds ratio 5.3; 95% CI 1.02-27.7). A difference of 1-2 days was seen in clinical recovery. No difference was found in daily activities between the treatment groups. After 2 days, 4% of the penicillin-treated patients harboured GABHS compared with 75% of the placebo group. CONCLUSION: Only GABHS-positive patients benefit from penicillin V in their clinical cure in the first few days. Therefore, rapid testing is necessary. Treatment may be beneficial with regard to the clinical course, but it is not necessary.

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  • Komaroff AL, Pass TM, Aronson MD, Ervin CT, Cretin S, Winickoff RN, Branch WT., Jr The prediction of streptococcal pharyngitis in adults. J Gen Intern Med. 1986 Jan-Feb;1(1):1–7. [PubMed]
  • Dagnelie CF, Touw-Otten FW, Kuyvenhoven MM, Rozenberg-Arska M, de Melker RA. Bacterial flora in patients presenting with sore throat in Dutch general practice. Fam Pract. 1993 Dec;10(4):371–377. [PubMed]
  • DENNY FW, WANNAMAKER LW, BRINK WR, RAMMELKAMP CH, Jr, CUSTER EA. Prevention of rheumatic fever; treatment of the preceding streptococcic infection. J Am Med Assoc. 1950 May 13;143(2):151–153. [PubMed]
  • Sanders CC, Sanders WE, Jr, Harrowe DJ. Bacterial interference: effects of oral antibiotics on the normal throat flora and its ability to interfere with group A streptococci. Infect Immun. 1976 Mar;13(3):808–812. [PMC free article] [PubMed]
  • Pichichero ME, Disney FA, Talpey WB, Green JL, Francis AB, Roghmann KJ, Hoekelman RA. Adverse and beneficial effects of immediate treatment of Group A beta-hemolytic streptococcal pharyngitis with penicillin. Pediatr Infect Dis J. 1987 Jul;6(7):635–643. [PubMed]
  • Gerber MA, Markowitz M. Management of streptococcal pharyngitis reconsidered. Pediatr Infect Dis. 1985 Sep-Oct;4(5):518–526. [PubMed]
  • Randolph MF, Gerber MA, DeMeo KK, Wright L. Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis. J Pediatr. 1985 Jun;106(6):870–875. [PubMed]
  • De Meyere M, Mervielde Y, Verschraegen G, Bogaert M. Effect of penicillin on the clinical course of streptococcal pharyngitis in general practice. Eur J Clin Pharmacol. 1992;43(6):581–585. [PubMed]
  • Krober MS, Bass JW, Michels GN. Streptococcal pharyngitis. Placebo-controlled double-blind evaluation of clinical response to penicillin therapy. JAMA. 1985 Mar 1;253(9):1271–1274. [PubMed]
  • Middleton DB, D'Amico F, Merenstein JH. Standardized symptomatic treatment versus penicillin as initial therapy for streptococcal pharyngitis. J Pediatr. 1988 Dec;113(6):1089–1094. [PubMed]
  • Whitfield MJ, Hughes AO. Penicillin in sore throat. Practitioner. 1981 Feb;225(1352):234–239. [PubMed]
  • Gibbons A. Exploring new strategies to fight drug-resistant microbes. Science. 1992 Aug 21;257(5073):1036–1038. [PubMed]
  • Cone LA, Woodard DR, Schlievert PM, Tomory GS. Clinical and bacteriologic observations of a toxic shock-like syndrome due to Streptococcus pyogenes. N Engl J Med. 1987 Jul 16;317(3):146–149. [PubMed]
  • Gunzenhauser JD, Longfield JN, Brundage JF, Kaplan EL, Miller RN, Brandt CA. Epidemic streptococcal disease among Army trainees, July 1989 through June 1991. J Infect Dis. 1995 Jul;172(1):124–131. [PubMed]
  • Touw-Otten FW, Johansen KS. Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries. Fam Pract. 1992 Sep;9(3):255–262. [PubMed]
  • Centor RM, Meier FA, Dalton HP. Throat cultures and rapid tests for diagnosis of group A streptococcal pharyngitis. Ann Intern Med. 1986 Dec;105(6):892–899. [PubMed]
  • Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1(3):239–246. [PubMed]
  • Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975 Sep;1(3):277–299. [PubMed]
  • Stevens DL, Tanner MH, Winship J, Swarts R, Ries KM, Schlievert PM, Kaplan E. Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med. 1989 Jul 6;321(1):1–7. [PubMed]
  • Radetsky M, Wheeler RC, Roe MH, Todd JK. Comparative evaluation of kits for rapid diagnosis of group A streptococcal disease. Pediatr Infect Dis. 1985 May-Jun;4(3):274–281. [PubMed]
  • el-Daher NT, Hijazi SS, Rawashdeh NM, al-Khalil IA, Abu-Ektaish FM, Abdel-Latif DI. Immediate vs. delayed treatment of group A beta-hemolytic streptococcal pharyngitis with penicillin V. Pediatr Infect Dis J. 1991 Feb;10(2):126–130. [PubMed]
  • Gerber MA, Randolph MF, DeMeo KK, Kaplan EL. Lack of impact of early antibiotic therapy for streptococcal pharyngitis on recurrence rates. J Pediatr. 1990 Dec;117(6):853–858. [PubMed]
  • Howie JG, Foggo BA. Antibiotics, sore throats and rheumatic fever. J R Coll Gen Pract. 1985 May;35(274):223–224. [PMC free article] [PubMed]
  • de Melker RA, Kuyvenhoven MM. Management of upper respiratory tract infections in Dutch family practice. J Fam Pract. 1994 Apr;38(4):353–357. [PubMed]

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