Howe R W, Millar M R, Coast J, Whitfield M, Peters T J, Brookes S
Department of Social Medicine, University of Bristol.
Br J Gen Pract. 1997 May;47(418):280-4.
Sore throat is a common symptom presented to general practitioners (GPs), and there remains controversy about the appropriate use of antibiotics.
To compare, in a randomized controlled trial, the effectiveness of penicillin, cefixime and placebo on symptom resolution in patients presenting with a sore throat in general practice.
Twenty-two GPs in Avon recruited 154 patients, aged 16-60 years, presenting to their GP with a sore throat, and for whom the GP would normally prescribe an antibiotic. Patients were randomized to one of three groups: penicillin V 250 mg four times a day; cefixime 200 mg daily; and placebo. Each was prescribed for five days. The main outcome measures were a diary of symptom resolution over seven days and eradication of group A beta-haemolytic streptococcus (GABHS).
Of the 103 (67%) patients who completed symptom diaries, 40 were allocated to receive penicillin, 29 cefixime and 34 placebo. In the analysis including all patients, symptom resolution was greater by day 3 in the cefixime group than in the placebo group. Penicillin did not improve symptom resolution by day 3 compared with placebo, and cefixime was not statistically significantly different from penicillin. There were significant differences in the proportion of patients using analgesia at day 3, with the proportion being lowest in the cefixime group. The results for the subgroup of patients without GABHS were similar to those for all patients; in particular, the only statistically significant difference was between cefixime and placebo. Although numbers were too small for statistical significance, among patients with GABHS the effects of penicillin and cefixime were similarly raised in relation to placebo.
Compared with placebo, cefixime can improve the rate of resolution of symptoms in patients with a sore throat who are selected for antibiotic treatment by their GP. The unexpected finding that cefixime was of benefit compared with placebo for patients without GABHS suggests that bacteria other than GABHS may be important in the pathogenesis of sore throat.
喉咙痛是全科医生（GP）接诊时常见的症状，关于抗生素的合理使用仍存在争议。
在一项随机对照试验中，比较青霉素、头孢克肟和安慰剂对全科医疗中喉咙痛患者症状缓解的有效性。
埃文郡的22名全科医生招募了154名年龄在16至60岁之间、因喉咙痛前来就诊且全科医生通常会开抗生素的患者。患者被随机分为三组之一：青霉素V 250毫克，每日四次；头孢克肟200毫克，每日一次；以及安慰剂。每种药物均服用五天。主要结局指标是七天内症状缓解的日记以及A组β溶血性链球菌（GABHS）的清除情况。
在完成症状日记的103名（67%）患者中，40名被分配接受青霉素治疗，29名接受头孢克肟治疗，34名接受安慰剂治疗。在包括所有患者的分析中，头孢克肟组在第3天时症状缓解情况优于安慰剂组。与安慰剂相比，青霉素在第3天时并未改善症状缓解情况，且头孢克肟与青霉素之间无统计学显著差异。在第3天时使用镇痛药的患者比例存在显著差异，头孢克肟组的比例最低。无GABHS患者亚组的结果与所有患者的结果相似；特别是，唯一具有统计学显著差异的是头孢克肟组与安慰剂组之间。尽管样本数量过少无法得出统计学显著性，但在患有GABHS的患者中，青霉素和头孢克肟相对于安慰剂的效果同样有所提高。
与安慰剂相比，头孢克肟可提高被全科医生选择进行抗生素治疗的喉咙痛患者的症状缓解率。头孢克肟对无GABHS患者比安慰剂更有益这一意外发现表明，除GABHS外的其他细菌可能在喉咙痛的发病机制中起重要作用。
