Curtin-Wirt Correne, Casey Janet R, Murray Patrick C, Cleary Carolyn T, Hoeger William J, Marsocci Steven M, Murphy Marie Lynd, Francis Anne B, Pichichero Michael E
Elmwood Pediatric Group, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
Clin Pediatr (Phila). 2003 Apr;42(3):219-25. doi: 10.1177/000992280304200305.
The purpose of this study was to compare the bacteriologic and clinical efficacy of oral penicillin versus amoxicillin as first-line therapy for group A beta-hemolytic streptococcal (GABHS) tonsillopharyngitis. The prospective observational study was conducted over 18 months (January 2000-June 2001). Children enrolled had acute onset of symptoms and signs and a laboratory-documented GABHS tonsillopharyngitis illness. Follow-up examination and laboratory testing occurred 10 +/- 4 days following completion of treatment. In total, 389 patients were enrolled (intent-to-treat group): 195 received penicillin V and 194 received amoxicillin. Fifty-six of the penicillin-treated and 57 amoxicillin-treated patients refused to take the drug, or were noncompliant, or did not return for the follow-up visit, leaving 276 patients in the per-protocol group: 139 penicillin-treated and 137 amoxicillin-treated. Bacteriologic cure for amoxicillin-treated children occurred in 76% versus 64% in the penicillin-treated children (p = 0.04). The clinical cure rate for amoxicillin-treated children was 84% compared to 73% in the penicillin-treated children (p = 0.03). Since treatment allocation was not randomized, logistic regression analysis was used to adjust for treatment group differences. The odds ratio (OR) estimate for cure for patients in the amoxicillin versus penicillin V treatment group remained significant (OR = 1.84, 95% confidence interval 1.02-3.29); the same was true for dinical cure (OR = 1.99, 95% CI = 1.02-3.87). Amoxicillin may be superior to penicillin for bacteriologic and clinical cure of GABHS tonsillopharyngitis.
本研究的目的是比较口服青霉素与阿莫西林作为 A 组β溶血性链球菌（GABHS）扁桃体咽炎一线治疗药物的细菌学疗效和临床疗效。这项前瞻性观察性研究历时 18 个月（2000 年 1 月至 2001 年 6 月）。纳入的儿童有急性症状和体征，且实验室确诊为 GABHS 扁桃体咽炎。治疗结束后 10±4 天进行随访检查和实验室检测。总共纳入了 389 名患者（意向性治疗组）：195 名接受青霉素 V 治疗，194 名接受阿莫西林治疗。56 名接受青霉素治疗的患者和 57 名接受阿莫西林治疗的患者拒绝服药、不依从或未返回进行随访，使得符合方案组有 276 名患者：139 名接受青霉素治疗，137 名接受阿莫西林治疗。接受阿莫西林治疗的儿童细菌学治愈率为 76%，而接受青霉素治疗的儿童为 64%（p = 0.04）。接受阿莫西林治疗的儿童临床治愈率为 84%，而接受青霉素治疗的儿童为 73%（p = 0.03）。由于治疗分配并非随机，因此采用逻辑回归分析来调整治疗组差异。阿莫西林治疗组与青霉素 V 治疗组患者治愈的优势比（OR）估计值仍具有显著性（OR = 1.84，95%置信区间 1.02 - 3.29）；临床治愈情况也是如此（OR = 1.99，95%CI = 1.02 - 3.87）。对于 GABHS 扁桃体咽炎的细菌学和临床治愈，阿莫西林可能优于青霉素。
