This Cochrane review compared the efficacy of 2 to 6 days of newer oral antibiotics (short duration) with 10 days of oral penicillin (standard duration) in treating children with acute group A beta hemolytic streptococcus (GABHS) pharyngitis. It found that 3 to 6 days of oral antibiotics had comparable efficacy to a 10 day course of oral penicillin. The authors suggest that in countries with low rates of rheumatic fever, it appears safe and efficacious to treat such children with short duration antibiotics, but in areas where the prevalence of rheumatic heart disease is still high, these results must be interpreted with caution.

The review included 20 studies (n = 13,102) and reported that:

• Compared to standard duration, the short duration treatment had shorter periods of fever (mean difference -0.30 days) and throat soreness (-0.50 days).

• Compared to standard duration, the short duration treatment had lower risk of early clinical treatment failure (odds ratio 0.80, 95% CI, 0.67 to 0.94).

• There was no significant difference in early bacteriological treatment failure (1.08, 0.97 to 1.20) or late clinical recurrence (0.95, 0.83 to 1.08).

• The overall risk of late bacteriological recurrence was worse in the short duration treatment group (1.31, 1.16 to 1.48), although no significant differences were found when studies of low dose azithromycin (10mg/kg) were eliminated.

• Three studies reported long duration complications with no statistically significant difference.