Pharyngotonsillitis: 5 days of Penicillin V

Sore throat is a common reason for antibiotic prescribing. This trial assesses whether a four times per day for five days versus three times per day for 10 days course of antibiotics can be prescribed while maintaining clinical efficacy.

Penicillin is the preferred first-choice antibiotic treatment for adults and children with tonsillopharyngitis. Usual treatment advice involves a 10-day course of phenoxymethylpenicillin (penicillin V).

Advice to take and complete longer courses of antibiotics is largely based on avoiding serious complications; however, in developed countries, complications of tonsillitis such as acute rheumatic fever and glomerulonephritis are very rare.2 

A previous Cochrane review of 20 studies including 13 102 children with acute streptococcal pharyngitis showed that 3–6 days of late-generation antibiotics, including oral penicillin V, had comparable efficacy to a 10-day course.2 The advice on duration of antibiotic use, however, is based on limited evidence and shorter antibiotic courses may be a safe and effective way to address antibiotic overuse.3

EBM Verdict on: Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non- inferiority study. BMJ 2019;367:l5337. doi: 10.1136/ bmj.l5337.
► A 5-day course of penicillin appears to be as effective as a 10-day course for pharyngotonsillitis with fewer side effects for patients.


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