Treatment outcomes of acute streptococcal tonsillitis according to antibiotic treatment. A retrospective analysis of 242,366 cases treated in the community

Figures & data

Table 1. Patient characteristics, antibiotic treatment dispensed and rate of complications at 90 days follow-up.

Characteristics	%, (n)
Gender
Male, % (n)	44.7% (108,327)
Female, % (n)	55.3% (134,039)
Age
<3 years, % (n)	8.2% (19,880)
3–15 years, % (n)	57.6% (139,655)
16–45 years, % (n)	29.5% (71,527)
>46 years, % (n)	4.7% (11,304)
Antibiotic treatment
Amoxicillin, % (n)	55.4% (134,266)
Phenoxymethylpenicillin, % (n)	32.6% (79,109)
Amoxicillin/clavulanate, % (n)	3.7% (9077)
Benzathine benzylpenicillin, % (n)	0.1% (267)
Cephalosporin, % (n)	1.9% (4601)
Macrolide, % (n)	6.2% (15,046)
Prescribing physician
Primary	83% (202,120)
-Family physician	29% (70,063)
-Pediatrician	54% (132,057)
Secondary	0.37% (900)
-ENT	0.27% (669)
-Other secondary	0.1% (231)
Unknown	16% (39,346)
Complication rate, 90 days
Peritonsillar and retropharyngeal abscess, % (n)	0.2% (379)
Post-streptococcal glomerulonephritis, % (n)	0.01% (21)
Rheumatic fever, % (n)	0.02% (46)
Acute rheumatic heart disease, % (n)	0.004% (10)
Post-streptococcal arthritis, % (n)	0.005% (13)
Chorea, % (n)	0.001% (3)
Death, any cause, % (n)	0.002% (4)

Table 2. Multivariate analysis of additional visits according to antibiotic treatment.

	Antibiotic treatment	Adjusted OR (95%CI)	PV
Additional visits, any cause, at 30 days	Phenoxymethylpenicillin	Reference
	Amoxicillin	1.07 (1.06–1.08)	<0.001
	Amoxicillin/clavulanate	1.12 (1.09–1.14)	<0.001
	Benzathine benzylpenicillin	1.46 (1.33–1.60)	<0.001
	Cephalosporin	1.27 (1.24–1.30)	<0.001
	Macrolide	1.15 (1.13–1.17)	<0.001
Additional visits, any cause, at 60 days	Phenoxymethylpenicillin	Reference
	Amoxicillin	1.09 (1.08–1.10)	<0.001
	Amoxicillin/clavulanate	1.13 (1.11–1.15)	<0.001
	Benzathine benzylpenicillin	1.39 (1.28–1.51)	<0.001
	Cephalosporin	1.27 (1.24–1.30)	<0.001
	Macrolide	1.15 (1.13–1.16)	<0.001
Additional visits, any cause, at 90 days	Phenoxymethylpenicillin	Reference
	Amoxicillin	1.10 (1.09–1.11)	<0.001
	Amoxicillin/clavulanate	1.12 (1.11–1.14)	<0.001
	Benzathine benzylpenicillin	1.36 (1.27–1.46)	<0.001
	Cephalosporin	1.26 (1.23–1.28)	<0.001
	Macrolide	1.16 (1.15–1.17)	<0.001
Additional visits, due to pharyngitis, tonsillitis or sore throat, at 90 days	Phenoxymethylpenicillin	Reference
	Amoxicillin	1.02 (1.01–1.03)	<0.001
	Amoxicillin/clavulanate	1.18 (1.15–1.20)	<0.001
	Benzathine benzylpenicillin	1.55 (1.40–1.71)	<0.001
	Cephalosporin	1.18 (1.15–1.21)	<0.001
	Macrolide	1.12 (1.10–1.14)	<0.001
Additional visits due to otitis media, at 90 days	Phenoxymethylpenicillin	Reference
	Amoxicillin	1.59 (1.5–1.68)	<0.001
	Amoxicillin/clavulanate	2.38 (2.14–2.64)	<0.001
	Benzathine benzylpenicillin	0.67 (0.30–1.50)	0.33
	Cephalosporin	1.85 (1.61–2.12)	<0.001
	Macrolide	1.76 (1.62–1.91)	<0.001
Additional visits due to upper respiratory tract infection, at 90 days	Phenoxymethylpenicillin	Reference
	Amoxicillin	1.20 (1.17–1.22)	<0.001
	Amoxicillin/clavulanate	1.17 (1.11–1.22)	<0.001
	Benzathine benzylpenicillin	1.23 (0.98–1.53)	0.067
	Cephalosporin	1.17 (1.10–1.24)	<0.001
	Macrolide	1.19 (1.15–1.23)	<0.001
Additional visits due to acute sinusitis, at 90 days	Phenoxymethylpenicillin	Reference
	Amoxicillin	0.98 (0.90–1.07)	0.67
	Amoxicillin/clavulanate	1.74 (1.55–1.95)	<0.001
	Benzathine benzylpenicillin	0.65 (0.21–2.03)	0.46
	Cephalosporin	1.31 (1.10–1.58)	0.003
	Macrolide	1.14 (1.00–1.31)	0.05

Table 3. Multivariate analysis of complication according to antibiotic treatment.

	Antibiotic treatment	Adjusted OR (95%CI)	PV
Peritonsillar or retropharyngeal abscess	Phenoxymethylpenicillin	Reference
	Amoxicillin	0.75 (0.55–1.02)	0.07
	Amoxicillin/clavulanate	6.26 (4.85–8.09)	<0.001
	Benzathine benzylpenicillin	8.61 (2.71–27.38)	<0.001
	Cephalosporin	2.34 (1.43–3.84)	0.001
	Macrolide	1.85 (1.27–2.69)	0.001
Any complication	Phenoxymethylpenicillin	Reference
	Amoxicillin	0.68 (0.52–0.89)	<0.01
	Amoxicillin/clavulanate	5.28 (4.15–6.71)	<0.001
	Benzathine benzylpenicillin	10.77 (4.37–26.56)	<0.001
	Cephalosporin	2.75 (1.82–4.13)	<0.001
	Macrolide	1.41 (0.98–2.02)	0.06