As a treatment for sore throat in children, penicillin does not reduce the duration of symptoms or decrease the need for pain relievers. Although there has been evidence that penicillin helps prevent complications of streptococcal infections, these complications can usually be safely treated if they occur.
Researchers from the University Medical Centre, Utrecht, studied 156 children with a sore throat who were randomly assigned to receive penicillin for three days then placebo for four days; penicillin for seven days; or placebo for seven days. In all cases, the sore throat had been present for less than seven days and each child met at least two criteria for streptococcal sore throat: fever, no cough, swollen and tender lymph nodes in the neck and tonsil involvement.
It was found that penicillin therapy - given for three or seven days -offered no therapeutic benefits and did not promote a faster return to school or prevent recurrences. Moreover, this held true even when the analysis was limited to the 96 patients who actually tested positive for group A streptococci. Only one child in the seven-day penicillin group and two in the three-day penicillin group experienced complications of streptococcal infection, compared with eight children in the placebo group. All of these patients were successfully treated with antibiotic therapy and none required hospitalisation.
According to the researchers, there is an 'extremely low' rate of potentially severe post-streptococcal complications, such as rheumatic fever, in wealthy Western countries. As these countries also have rising antibiotic resistance rates and a high rate of children who are carriers of group A streptococci, they advocate prudent prescription behaviour with respect to penicillin.
BMJ, December, 2003