Clinical And Bacteriological Impact Of Clarithromycin In Streptococcal Pharyngitis: Findings From A Meta-Analysis Of Clinical Trials

Abstract

Introduction

Among the bacterial upper respiratory tract infections (UTRIs), the most medically significant is pharyngitis due to Group A beta-hemolytic Streptococci (GABHS). A 2012 meta-review and a 2016 Cochrane systematic review reported favorably on the comparative efficacy and safety of clarithromycin in pediatric patients with URTIs and in adults with GABHS pharyngitis. In this paper, the evidence base for clarithromycin in patients with URTIs is augmented by a meta-analysis of comparative studies in GABHS pharyngitis.

Methods

A series of five outpatient trials of clarithromycin for the treatment of streptococcal pharyngitis from an internal database were subjected to meta-analysis. Active comparators comprised penicillin VK and erythromycin.

Results

Rates of clinical cure or improvement were very similar in all treatment assignments, but the rates of bacteriological cure were numerically higher with clarithromycin than with comparator antibiotics. Adverse events data indicated that clarithromycin was generally well tolerated in these studies, with a relatively low incidence of adverse events and few severe incidents.

Discussion

Though currently not advised as a first-line therapy for URTI in most guidelines, the results of the meta-analysis indicate that clarithromycin is nevertheless a valid, effective and largely well-tolerated treatment option for GABHS pharyngitis patients who cannot benefit from other agents.

Keywords:

• clarithromycin
• erythromycin
• amoxicillin
• Streptococcus
• pharyngitis
• metaanalysis

Acknowledgments

The authors thank Dr Wilhelm Sauermann, DATAMAP GmbH, Freiburg for his contribution to data extraction and analysis, undertaken in the context a commercial contract. Abbott Products Operations AG, Allschwil, Switzerland retained Hughes associates, Oxford, UK, to provide editorial assistance in the preparation of this report.

Data Access

The accessed data is not freely available.

Ethics Approval

Ethics approval for all five studies was obtained by the investigators.

Disclosure

Dr Nauta is a salaried full-time employee of Abbott Healthcare Products B.V., Weesp, The Netherlands, and owns company stock. Dr Hoban has in the past received grant support from Abbott and currently sits on Abbott Advisory boards and lectures for Abbott. This research was supported financially by Abbott Products Operations AG, Allschwil, Switzerland. The authors report no other conflicts of interest in this work.