Gopichand I, Williams G D, Medendorp S V, Saracusa C, Sabella C, Lampe J B, Garcia R E, Lebrun L, Goldfarb J
Division of Pediatrics and Adolescent Medicine, Cleveland Clinic Children's Hospital, Ohio 44195, USA.
Clin Pediatr (Phila). 1998 Jun;37(6):341-6. doi: 10.1177/000992289803700602.
A 10-day course of amoxicillin at a dosage of 40 mg per kilogram per day was compared with conventional (lower dosage) penicillin V therapy in the treatment of culture-proven Group A streptococcal pharyngitis in children 3 to 18 years of age in a prospective, randomized, and single-blinded study. Children had to have signs and symptoms compatible with the diagnosis of streptococcal pharyngitis and to have a throat swab positive for Group A streptococci. A second throat culture was obtained 10 to 14 days after the completion of therapy. Serotyping was performed to help differentiate carrier states from reinfections. Of 161 children enrolled, 113 were evaluable; 55 received penicillin and 58 received amoxicillin. At the completion of therapy 70.9% (39/55) of patients in the penicillin group vs 87.9% (51/58) of patients in the amoxicillin group were asymptomatic (clinical cure, P = 0.025). At the completion of therapy, 54.5% (30/55) of patients in the penicillin group vs 79.3% (46/58) of patients in the amoxicillin group had negative throat cultures (bacteriologic cure, P = 0.005). The carrier rate (children who were well but who were still carrying the same serotype of Group A streptococcus) also differed between the groups: 13 (23.6%) in the penicillin group compared with six (10.3%) in the amoxicillin group. Amoxicillin at 40 mg/kg/day was significantly more effective than lower dosages of penicillin V for clinical and bacteriologic cure in the treatment of Group A streptococcal pharyngitis in children. The current perception that penicillin is declining in effectiveness may be due to inadequate dosing.
在一项前瞻性、随机、单盲研究中，对3至18岁儿童确诊为A组链球菌性咽炎的患者，比较了剂量为每日每千克40毫克的阿莫西林10天疗程与传统（较低剂量）青霉素V疗法的疗效。儿童必须有与链球菌性咽炎诊断相符的体征和症状，且咽拭子A组链球菌检测呈阳性。治疗结束后10至14天进行第二次咽拭子培养。进行血清分型以帮助区分带菌状态和再感染。在161名登记的儿童中，113名可进行评估；55名接受青霉素治疗，58名接受阿莫西林治疗。治疗结束时，青霉素组70.9%（39/55）的患者无症状（临床治愈，P = 0.025），而阿莫西林组为87.9%（51/58）。治疗结束时，青霉素组54.5%（30/55）的患者咽拭子培养阴性（细菌学治愈，P = 0.005），而阿莫西林组为79.3%（46/58）。两组的带菌率（身体状况良好但仍携带相同血清型A组链球菌的儿童）也有所不同：青霉素组为13名（23.6%），阿莫西林组为6名（10.3%）。对于儿童A组链球菌性咽炎的临床和细菌学治愈，每日每千克40毫克的阿莫西林比低剂量的青霉素V显著更有效。目前认为青霉素有效性下降的观点可能是由于剂量不足。
