Summary of findings 1. Cephalosporins versus penicillin for group A streptococcal pharyngitis.
| Cephalosporinsversus penicillin for group A streptococcal pharyngitis | ||||||
| Patient or population: group A streptococcal pharyngitis Setting: outpatients Intervention: cephalosporin Comparison: penicillin | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with penicillin | Risk with cephalosporin | |||||
| Resolution of symptoms post‐treatment (ITT analysis) | Study population | OR 0.79 (0.55 to 1.12) | 2018 (5 RCTs) | ⊕⊕⊝⊝ LOWa,b | Outcome measured at 2 to 15 days or more post‐treatment. Subgroup analyses: Adults: OR 0.78 (0.60 to 1.01; 2 trials; 1163 participants; low‐certainty evidence) Children: OR 0.83 (0.40 to 1.73; 3 trials; 855 participants; very low‐certainty evidence) Note: The ITT analysis uses the number of participants randomised as the denominator for each outcome. We considered the participants for whom an outcome was not reported as treatment failures. |
|
| 245 per 1000 | 204 per 1000 (151 to 267) | |||||
| Resolution of symptoms post‐treatment (evaluable participants) | Study population | OR 0.51 (0.27 to 0.97) | 1660 (5 RCTs) | ⊕⊝⊝⊝ VERY LOWa,b,c | Outcome measured at 2 to 15 days or more post‐treatment. Note: The 'evaluable participants' analysis includes only those randomised participants for whom an outcome was reported. |
|
| 112 per 1000 | 60 per 1000 (33 to 109) | |||||
| Incidence of relapse (evaluable participants) | Study population | OR 0.55 (0.30 to 0.99) | 1386 (4 RCTs) | ⊕⊕⊝⊝ LOWa,b | Outcome measured at 17 to 90 days post‐treatment. Note: The 'evaluable participants' analysis includes only those randomised participants for whom an outcome was reported. |
|
| 46 per 1000 | 26 per 1000 (14 to 45) | |||||
| Adverse events (ITT analysis) | Study population | OR 0.94 (0.27 to 3.25) | 1279 (3 RCTs) | ⊕⊝⊝⊝ VERY LOWa,b,c | Note: The ITT analysis uses the number of participants randomised as the denominator for each outcome. We considered the participants for whom an outcome was not reported as treatment failures. | |
| 193 per 1000 | 184 per 1000 (61 to 438) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; ITT: intention‐to‐treat; OR: odds ratio; RCT: randomised controlled trial | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded 1 level due to unclear randomisation and blinding. bDowngraded 1 level due to wide confidence intervals. cDowngraded 1 level due to heterogeneity.