Use of antibiotics in sore throat in which GABHS has been detected

Most trials have compared penicillin with a variety of other antibiotics, notably cephalosporins. Although optimum elimination of GABHS is secured with intramuscular long-acting penicillin,⁶⁸ oral penicillin V given 6-hourly for 10 days is widely regarded as the `gold standard' treatment in such trials,^{46, 69} with the advantages of cheapness and tolerability. Other more expensive antibiotics, mainly cephalosporins, have been shown to be statistically significantly more successful in eradicating the organism^{45, 70} although the clinical advantage is much less clear. Some cephalosporins offer a more convenient dosage regimen⁷¹ but twice and three times daily dosage for oral penicillin V have also been shown to be effective in eliminating GABHS.^{69, 72, 73} A 10-day course of penicillin appears to be more effective than five days.⁶⁹ There is no convincing evidence of advantage for any individual cephalosporin.

Use of antibiotics in sore throat in which GABHS has not been detected

The limitations of performing throat swabs and of isolating, or failing to isolate, GABHS must be re-emphasised (see section 3). There is evidence from a small American study of 26 patients that erythromycin may provide symptomatic relief in non-streptococcal sore throat.⁵⁰ A recent UK study suggests that a cephalosporin may improve the rate of resolution of symptoms.⁷⁴ However, there is no convincing evidence of benefit from antibiotic therapy as primary treatment for sore throat.