Another approach to curing strep throat

For 50 years, the common wisdom has been that a child’s strep throat is best treated with that tried-and-true remedy: penicillin. But a review of dozens of previous studies involving thousands of youngsters has found that newer antibiotics called cephalosporins are better than penicillin at curing kids’ infections.

Oral cephalosporins, available since the 1970s, include the drugs cephalexin, cefadroxil, cefuroxime, cefprozil and cefdinir, which are safe for children and teens and can be taken in liquid and pill forms. Although they’ve been part of doctors’ arsenals for decades, penicillin has been favored because doctors thought it was the only drug that might prevent kids’ strep infections from causing rheumatic heart disease, a potentially deadly complication, said Dr. Janet Casey, who led the study review.

Casey, a pediatrician at the University of Rochester in New York, said she hoped the findings would prompt medical organizations, including the American Academy of Pediatrics, to reconsider guidelines that recommend penicillin as the first-line treatment for strep throat. Such recommendations ignore the fact that penicillin has a documented failure rate of up to 42%, she said, which means sick youngsters often must return to their doctors’ offices after penicillin treatment fails.

In a commentary that was to accompany Casey’s study in the April issue of Pediatrics (but was inadvertently omitted and will be published in the June issue), Dr. Stanford T. Shulman of Northwestern University and Dr. Michael A. Gerber of the University of Cincinnati faulted the new analysis for relying on several flawed studies. They said penicillin had “stood the test of time satisfactorily for five decades,” adding that “there are compelling reasons to continue to recommend it as the drug of choice.”

In any case, doctors advise parents who suspect strep throat to contact their child’s pediatrician.