Newer antibiotics like cephalosporins will replace penicillin and amoxicillin when it comes to treating ailments like strep throat, as they are seen to be more effective. Doctors, who reviewed the treatment given to 11,426 children, showed that even a short course of the newer drugs is more effective than the traditional 10-day dose of the older antibiotics.
Pediatricians at the University of Rochester Medical Center found that 25% of the children treated for strep throat with penicillin ended up back in the doctor's office within three weeks of treatment. Children treated with amoxicillin returned 18% of the time. The numbers were 14% for older-generation cephalosporins, and just 7% for newer ones like cefpodoxime and cefdinir, which are given for just four or five days.
"Most doctors are shocked to learn of the high failure rates of the older medications. The treatment paradigm for treating strep sore throats has been changing slowly, and endorsing the use of cephalosporins as a first-line treatment is something that needs to be seriously considered," said Pichichero, a professor of Microbiology and Immunology.
While the newer short-course cephalosporins are only available in brand-name form and are much more expensive, older ones such as cephalexin (better known as Keflex) cost about the same as penicillin or amoxicillin but are more effective against strep.
Nearly all drugs fail some of the time and doctors accept some risk of failure as a trade-off for other factors like convenience, cost to families, and likelihood that a less powerful medication can kill the bug just as well as a more powerful drug. In the case of throat infections, doctors try to preserve their strongest antibiotics for the most severe cases. But most doctors would view a drug that fails in one out of four patients, as penicillin does in strep cases, as unacceptable, Pichichero said.
Pichichero said children and parents are much more likely to adhere to taking all the prescribed medication in four or five days rather than 10 days. He noted that other studies have found that anywhere from 30% to 70% of parents make the mistake of discontinuing antibiotic medication for their children prematurely, or giving them leftover medication later on.
Sometimes it's just a misinformed attempt to give children less medication, but more often parents believe the drugs are no longer needed since the children are feeling better, despite the medication label that urges parents to make sure the child finishes all the medications.
The good intentions directly lead to children becoming sick on and off for weeks or months, as the strep germ isn't quite killed off but instead lingers in the child's body. The children also become vulnerable to much more severe infections that will demand the use of even stronger drugs later on. All the while, the still-contagious child is exposing his or her friends to strep.