Trial reportBMJ (Clinical research ed.)2019
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.
Trial report in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02712307 (A Randomized Controlled Study of 5 and 10 Days Treatment With Phenoxymethylpenicillin for Pharyngotonsillitis Caused by Streptococcus Group A), which is not on this map. Cited by 26 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomized Controlled Study of 5 and 10 Days Treatment With Phenoxymethylpenicillin for Pharyngotonsillitis Caused by Streptococcus Group A
Who cites it
26 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Patient and public involvement and engagement (PPIE) in Otolaryngology research: a systematic review of randomised controlled trials.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2025Pooled it
- Pooled it
- Addition of probenecid to oral β-lactam antibiotics: a systematic review and meta-analysis.The Journal of antimicrobial chemotherapy · 2022Pooled it
- Effect of a Widespread Reduction in Treatment Duration for Group A Streptococcal Pharyngitis on Outcomes Including Household Transmission.Open forum infectious diseases · 2025Trial
- Towards pharmacokinetic boosting of phenoxymethylpenicillin (penicillin-V) using probenecid for the treatment of bacterial infections.Scientific reports · 2024Trial
- Clinical course of pharyngotonsillitis with group A streptococcus treated with different penicillin V strategies, divided in groups of Centor Score 3 and 4: a prospective study in primary care.BMC infectious diseases · 2022Trial
- Streptococcal Pharyngitis in Paediatric Primary Care: Clinical Characteristics, Recurrences, Complications, and Antibiotic Management.Infectious diseases and therapy · 2026Article
- Primary care pharyngotonsillitis complications following absent or deferred antibiotic treatment across the COVID 19 pandemic.Communications medicine · 2026Article
- The Invisible Excess: Too Long Antibiotic Duration in the Pediatric Emergency Care.Antibiotics (Basel, Switzerland) · 2026Article
- Article
- The Role of Physical Examination and Clinical Scores in Distinguishing Streptococcal Colonization from Pharyngitis in Pediatric Patients: Insights from a Common Clinical Scenario.Microorganisms · 2025Article
- Comparative efficacy and safety of co-amoxiclav, cefpodoxime proxetil, and levofloxacin in patients with acute uncomplicated bacterial tonsillitis: A prospective, open-label, parallel group study.Journal of family medicine and primary care · 2024Article
- Optimising antibiotic exposure by customising the duration of treatment for respiratory tract infections based on patient needs in primary care.EClinicalMedicine · 2024Review
- A 6-year review of acute post-streptococcal glomerulonephritis at a public children's hospital in Cape Town, South Africa.Pediatric nephrology (Berlin, Germany) · 2024Article
- Agreement between rapid antigen detection test and culture for group A streptococcus in patients recently treated for pharyngotonsillitis - a prospective observational study in primary care.Scandinavian journal of primary health care · 2023Observational
- Associations Between Findings of Fusobacterium necrophorum or β-Hemolytic Streptococci and Complications in Pharyngotonsillitis-A Registry-Based Study in Southern Sweden.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Effects of penicillin V on the faecal microbiota in patients with pharyngotonsillitis-an observational study.JAC-antimicrobial resistance · 2023Article
- Short-term antibiotic therapy for the most common bacterial respiratory infections in infants and children.Frontiers in pharmacology · 2023Review
- Throat infections and use of streptococcal antigen test and antibiotic treatment in general practice; a web-based survey.Scandinavian journal of primary health care · 2022Article
- Exploring the Pharmacokinetics of Phenoxymethylpenicillin (Penicillin-V) in Adults: A Healthy Volunteer Study.Open forum infectious diseases · 2021Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine whether total exposure to penicillin V can be reduced while maintaining adequate clinical efficacy when treating pharyngotonsillitis caused by group A streptococci.
designOpen label, randomised controlled non-inferiority study.
setting17 primary healthcare centres in Sweden between September 2015 and February 2018.
participantsPatients aged 6 years and over with pharyngotonsillitis caused by group A streptococci and three or four Centor criteria (fever ≥38.5°C, tender lymph nodes, coatings of the tonsils, and absence of cough).
interventionsPenicillin V 800 mg four times daily for five days (total 16 g) compared with the current recommended dose of 1000 mg three times daily for 10 days (total 30 g).
main outcome measuresPrimary outcome was clinical cure five to seven days after the end of antibiotic treatment. The non-inferiority margin was prespecified to 10 percentage points. Secondary outcomes were bacteriological eradication, time to relief of symptoms, frequency of relapses, complications and new tonsillitis, and patterns of adverse events.
resultsPatients (n=433) were randomly allocated to the five day (n=215) or 10 day (n=218) regimen. Clinical cure in the per protocol population was 89.6% (n=181/202) in the five day group and 93.3% (n=182/195) in the 10 day group (95% confidence interval -9.7 to 2.2). Bacteriological eradication was 80.4% (n=156/194) in the five day group and 90.7% (n=165/182) in the 10 day group. Eight and seven patients had relapses, no patients and four patients had complications, and six and 13 patients had new tonsillitis in the five day and 10 day groups, respectively. Time to relief of symptoms was shorter in the five day group. Adverse events were mainly diarrhoea, nausea, and vulvovaginal disorders; the 10 day group had higher incidence and longer duration of adverse events.
conclusionsPenicillin V four times daily for five days was non-inferior in clinical outcome to penicillin V three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci. The number of relapses and complications did not differ between the two intervention groups. Five day treatment with penicillin V four times daily might be an alternative to the currently recommended 10 day regimen.
trial registrationEudraCT 2015-001752-30; ClinicalTrials.gov NCT02712307.
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