Comparison of Three Antibiotics for Acute Uncomplicated Bacterial Tonsillitis, An Indian Study
Introduction
Acute tonsillitis, a common bacterial infection caused primarily by Group A beta-hemolytic Streptococci, leads to significant absenteeism and complications if untreated.
Aim
Compare the efficacy and safety of three antibiotics—co-amoxiclav (COA), cefpodoxime proxetil (CEF), and levofloxacin (LEV)—in treating acute uncomplicated bacterial tonsillitis.
Methods
- Prospective, open-label, parallel-group trial
- N=84 divided into three treatment groups
- Treatment Duration: 5 days
Fig: Treatment study groups and number of patients analysed
Study endpoints
Efficacy endpoints: Clinical Improvement, Bacteriological Cure
Safety Endpoints: Adverse events
Results
Clinical Improvement
- Day 3 and 7: COA, CEF, and LEV groups showed comparable clinical responses
- Day 5: LEV group showed a significantly reduced cure rate, but a higher improvement rate, than the COA and CEF groups
Table 1: Clinical Response Percentages Across Treatment Groups
|
Day |
Response |
Co‑amoxclav COA group (%) |
Cefpodoxime CEF group (%) |
Levofloxacin LEV group (%) |
P value |
|
Day 3 |
Improved |
96.7 |
93.3 |
100 |
0.770 |
|
Lost to follow‑up |
3.3 |
6.7 |
0 |
||
|
Day 5 |
Cured |
80 |
80 |
60 |
0.056 |
|
Improved |
16.7 |
13.3 |
40 |
||
|
Lost to follow‑up |
3.3 |
6.7 |
0 |
||
|
Day 7 |
Cured |
96.7 |
90 |
93.3 |
0.561 |
|
Treatment failure |
0 |
3.3 |
6.7 |
||
|
Lost to follow‑up |
3.3 |
6.7 |
0 |
Bacteriological Cure
Responses were similar in all three groups at week one.
Table 2: Culture Results Percentages at Baseline and 1 Week
|
Time Point |
Culture Result |
Co‑amoxclav COA group (%) |
Cefpodoxime CEF group (%) |
Levofloxacin LEV group (%) |
P value |
|
Baseline |
Beta‑hemolytic Streptococcus |
66.7 |
50 |
46.7 |
0.282 |
|
S. aureus |
23.3 |
46.7 |
43.3 |
||
|
Gram‑positive cocci & Gram‑negative bacilli |
10 |
3.3 |
10 |
||
|
1 Week |
No growth |
100 |
96.7 |
86.7 |
0.171 |
|
Gram‑positive cocci |
0 |
0 |
3.3 |
||
|
S. aureus |
0 |
0 |
3.3 |
||
|
Lost to follow‑up |
0 |
3.3 |
6.7 |
Safety
All drugs were well tolerated with a few self‑limiting adverse effects.
Conclusion
Co-amoxiclav, cefpodoxime proxetil, and levofloxacin were found to be equally effective and safe for treating acute uncomplicated bacterial tonsillitis, with minor differences in short-term response.
Reference
J Family Med Prim Care. 2024 Dec;13(12):5570-5574
