Angina is one of the most common reasons for seeing a doctor in children. About 15-30% of all detected cases of acute tonsillopharyngitis are caused by group A β-hemolytic streptococcus (BHCA). A randomized double-blind adult study showed that a 7-day course of penicillin was more effective in resolving the symptoms of streptococcal pharyngitis compared to a 3-day course. The same study was conducted in children.

Dutch researchers analyzed the results of penicillin treatment in 156 children aged 4 to 15 with angina pectoris. In all children, the duration of symptoms of acute tonsillopharyngitis before treatment was less than 7 days and at least 2 of the 4 diagnostic criteria of the Center were recorded: history of fever, absence of cough, presence of exudate on the tonsils , pain of the anterior cervical lymph nodes. Subsequently, in 96 children, BSA was isolated.

The children were randomized into 3 groups: the first group received a 7-day course of phenoxymethylpenicillin; the second is a 3-day course followed by a placebo for 4 days; the third placebo for 7 days. Children aged 4 to 10 years received 250 mg of the drug 3 times a day, children 10 years and older - 500 mg 3 times a day. The effectiveness of the treatment was evaluated by the duration of the persistence of the symptoms (until complete disappearance of the sore throat), the need for an additional prescription of analgesics (in days), the number of days missed by the school, the frequency of complications of streptococcal infection (paratonsillary abscess, scarlet fever, impetigo), the effectiveness of eradicating the pathogen after 2 weeks after the start of treatment, the occurrence of a relapse of the disease during for the next 6 months.

First, the duration of persistent sore throat was assessed. There was no difference between the group receiving the 7-day penicillin treatment and the group receiving the placebo (on average, it was 3.8 days). The duration of persistent sore throat while taking penicillin with a course of 3 days was (on average) 4.6 days. In children who received a 7-day course of penicillin, the sore throat resolved on average 0.5 days earlier than in children who took a placebo. And in the children who received a 3-day course of penicillin, the pain disappeared on average 1.3 days later compared to the placebo group. There was no difference in the longer-term additional administration of painkillers between the groups.

The percentage of nasopharyngeal BSA eradication was higher in the group receiving penicillin for 7 days (68%) compared to the 3-day course (35%) and placebo (28%).

11 children experienced complications after acute tonsillopharyngitis: in 9 patients - a paratonsillary abscess, in 1 child - scarlet fever, in 1 - impetigo. The highest complication rate was recorded in the placebo group - in 8 children (0.1%). Less frequently, complications occurred in the penicillin treatment group for 7 days (1 child, 0.02%). With a 3-day course, the complication rate was 0.04% (2 children). Adequate antibiotic therapy has been successfully conducted for children with developed complications; there were no cases of hospitalization.

The incidence of drug-related adverse events was almost the same in all three groups.

Although the treatment of pharyngitis in adults, especially the etiology of streptococci, with accelerated recovery of penicillin within 7 days, this effect has not been observed in children. This is probably due to more frequent cases of asymptomatic carriage of HBSS in children (30% vs 7% in adults), when a positive bacteriological test can be considered as a disease caused by GBSA.

With 3-day use of penicillin, the recovery rate slows in adults and children. The increase in the relapse rate at the end of the first week is explained by the fact that such a course reduces the natural immune response without eradication of the pathogen.

Due to the fact that in western countries the frequency of rheumatic fever is quite low, the level of BSA carriers in children is high and resistance to antibiotics increases, with acute tonsillopharyngitis in children, it is recommended to prescribe penicillin treatment only in severe cases (inability to swallow, threatening a paratonsillary abscess) and at high risk the development of serious complications (history of rheumatic fever, immune disorders, high prevalence of HABA infections in the population). In mild cases, the use of penicillin is irrational and if purulent complications occur, prompt treatment with antibiotics quickly stops them.