ABSTRACT
Treatment with rimantadine of influenza in children and the potential development of resistance in clinical isolates associated with therapy have not been previously studied. We compared rimantadine to acetaminophen therapy in a controlled, double-blind study of 91 children with influenza-like illness. Of 69 children with proven influenza A/H3N2 infection, 37 received rimantadine and 32 received acetaminophen for five days. Children receiving rimantadine showed significantly greater reduction in fever and improvement in daily scores for symptoms and severity of illness during the first three days. Viral shedding also diminished significantly during the first two days but subsequently increased such that by days 6 and 7 the proportion of children shedding virus, as well as the quantity of virus shed, was significantly greater in the rimantadine group. During the seven-day study, of the 22 children in the rimantadine group with serial isolates tested, ten (45.5%) had resistant isolates compared with two (12.5%) of those with serial isolates in the acetaminophen group (P less than .03). Thus, of the total 37 children in the rimantadine group, 27% were found to have resistant isolated compared with 6% in the total group receiving acetaminophen (P less than .04). Furthermore, the mean inhibitory concentration of rimantadine increased with time in the rimantadine group (r = .4, P = .002) but not in the acetaminophen group. Rimantadine therapy, thus, appears to be significantly more effective than acetaminophen in ameliorating the clinical signs and symptoms of influenza in children. Treatment with rimantadine was also associated with increased viral shedding after the medication was discontinued and with the development of resistance in the clinical isolates, the significance of which is unknown.
Subject(s)
Adamantane/analogs & derivatives , Influenza, Human/drug therapy , Rimantadine/therapeutic use , Acetaminophen/therapeutic use , Adolescent , Child , Child, Preschool , Clinical Trials as Topic , Double-Blind Method , Female , Humans , Infant , Male , Random AllocationABSTRACT
One hundred forty-two children with presumed Group A beta-hemolytic streptococcal (GABHS) pharyngitis were enrolled in a randomized double blind prospective study comparing the consequences of immediate penicillin treatment with treatment delayed for 48 to 56 hours. One hundred fourteen of the enrolled patients were culture-positive. An adverse impact of early antibiotic therapy was noted; the incidence of subsequent infections with GABHS was significantly greater in those treated at the initial office visit with penicillin. In the month following documented evaluation of GABHS, a recurrence occurred 2 times more frequently in those treated with penicillin immediately compared with those for whom treatment was delayed 48 to 56 hours. Late recurrences (beyond 1 month but in the same streptococcal season) occurred 8 times more frequently (P less than 0.035). Delay in penicillin treatment did not increase GABHS intrafamilial spread. Symptoms of both groups were assessed for 2 days following the initiation of treatment. Both placebo-treated and penicillin-treated groups used aspirin or acetaminophen ad libitum. Penicillin was shown to reduce fever and relieve sore throat, dysphagia, headache, abdominal pain, lethargy and anorexia significantly beyond that achieved with aspirin or acetaminophen alone. Penicillin had no effect on culture-negative cases.
Subject(s)
Penicillins/therapeutic use , Pharyngitis/drug therapy , Streptococcal Infections/drug therapy , Adolescent , Antibodies, Bacterial/analysis , Child , Child, Preschool , Double-Blind Method , Drug Administration Schedule , Humans , Patient Compliance , Penicillins/adverse effects , Pharyngitis/genetics , Prospective Studies , Random Allocation , Recurrence , Streptococcal Infections/genetics , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/immunologyABSTRACT
A total of 150 children from two pediatric practices with clinical and bacteriologic evidence of acute group A beta-hemolytic streptococcal (GABHS) pharyngitis randomly received cefadroxil monohydrate (75 children) or phenoxymethyl penicillin (75 children). Cefadroxil was given once daily, while penicillin was given three times daily. The treatment groups were similar in age, sex, race, illness severity, and acute GABHS symptomatology. Throat cultures were routine 3 to 5 days after the start of therapy and 2 and 14 days after the end of therapy. The bacterial cure rates were 90% (62 of 69) for cefadroxil-treated patients and 76% (52 of 68) for penicillin-treated patients. This difference was significant (P less than 0.04). The clinical response was satisfactory in 91% of cefadroxil-treated patients and 89% of penicillin-treated patients. We conclude that once-daily cefadroxil is at least as effective as three-times-daily penicillin in producing bacteriologic eradication and clinical symptomatic improvement in children with GABHS pharyngitis.
Subject(s)
Cefadroxil/therapeutic use , Penicillin V/therapeutic use , Pharyngitis/drug therapy , Streptococcal Infections/drug therapy , Child , Child, Preschool , Clinical Trials as Topic , Female , Humans , Male , Pharyngitis/etiology , Random AllocationABSTRACT
Cefaclor was used as a therapeutic agent in beta-haemolytic streptococcal throat infections in children in 3 separate studies. Although the numbers of patients in these ongoing studies are too small for valid statistical analysis, cefaclor was found to be (1) an effective agent in a dose of 20 mg/kg/day, (2) as effective as phenoxymethyl penicillin at identical dosages, and (3) equally effective at doses administered twice daily or thrice daily. It was well accepted by the patients, had minimal side effects, and produced no adverse effects in the peripheral blood.
