Elsevier

The Journal of Pediatrics

Volume 153, Issue 6, December 2008, Pages 799-802
The Journal of Pediatrics

Original article
Randomized, Comparative Efficacy Trial of Oral Penicillin Versus Cefuroxime for Perianal Streptococcal Dermatitis in Children

https://doi.org/10.1016/j.jpeds.2008.06.035Get rights and content

Objective

To investigate the efficacy of penicillin compared with cefuroxime for group A β-hemolytic Streptococcus pyogenes (GABHS) perianal dermatitis.

Study design

Children 1 to 16 years of age with signs and symptoms of perianal dermatitis and a positive anal swab were randomized to penicillin or cefuroxime treatment and were clinically re-evaluated on day 3 and at the end of treatment (cefuroxime, day 7; penicillin, day 10). An anal swab was obtained to document eradication of GABHS at the end of treatment. Severity of disease was assessed with a clinical score (perianal erythema, 5 points; perianal itch, 3 points; painful defecation, 3 points; constipation, 2 points).

Results

Patients were enrolled and randomly assigned to penicillin (n = 18) or cefuroxime (n = 17) treatment. Treatment with penicillin was inferior to cefuroxime, which led to premature study termination after consultation with the ethics committee. Clinical improvement was more rapid in the cefuroxime group (P = .028) and GAHBS was not isolated from the anus the last day of therapy in 13 of 14 patients treated with cefuroxime compared with 7 of 15 patients treated with penicillin (P < .01).

Conclusions

Cefuroxime was more effective than penicillin and therefore should be considered as the treatment of choice for perianal dermatitis due to GABHS.

Section snippets

Study Design and Sites

This prospective, open, randomized, controlled study was conducted from August 2005 to December 2006 in pediatric practices located in the region of Basel and the outpatient clinic of the University Children's Hospital of Basel.

Inclusion and Exclusion Criteria

Patients 1 to 16 years of age were eligible for enrollment if they presented with either the typical clinical sign of perianal erythema or at least 2 other signs or symptoms such as perianal itching, rectal pain, painful defecation, consequent constipation,

Results

A total of 35 patients (21 boys, 14 girls) were enrolled and randomly assigned to penicillin (n = 18) or cefuroxime (n = 17) treatment. Six of the 35 patients were dropouts (penicillin group, n = 3; cefuroxime group) due to negative initial anal culture (n = 4) or protocol violation (n = 2; refusal of 1 patient to take oral medicine and 1 patient lost to follow-up). No serious adverse event occurred.

Baseline characteristics of patients were similar in both treatment groups (Figure) with the

Discussion

The recommended treatment of choice for perianal dermatitis caused by GABHS has been a 10-day course of penicillin orally. Due to recurrence rates up to 39%,1 alternative antibiotic treatment has been proposed such as with a cephalosporin, macrolide, or a prolonged treatment with penicillin (up to several weeks).5 The current study was a prospective, randomized, controlled comparison assessing the efficacy of a 10-day penicillin treatment with a 7-day cefuroxime treatment.

Our results indicate

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    The authors declare no potential conflicts of interest.

    Clinical Trial Register number: NCT00261742.

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