Summary of findings 2. Macrolides versus penicillin for group A streptococcal pharyngitis.
| Macrolides versus penicillin for group A streptococcal pharyngitis | ||||||
| Patient or population: group A streptococcal pharyngitis Settings: outpatients Intervention: macrolide 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 macrolide | |||||
| Resolution of symptoms post‐treatment (ITT analysis) | Study population | OR 1.11 (0.92 to 1.35) | 1728 (6 RCTs) | ⊕⊕⊝⊝ LOWa,b | Outcome measured at 2 to 20 days post‐treatment. 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. |
|
| 423 per 1000 | 448 per 1000 (402 to 497) | |||||
| Resolution of symptoms post‐treatment (evaluable participants) | Study population | OR 0.79 (0.57 to 1.09) | 1159 (6 RCTs) | ⊕⊕⊝⊝ LOWa,b | Outcome measured at 2 to 20 days post‐treatment. Note: The 'evaluable participants' analysis includes only those randomised participants for whom an outcome was reported. |
|
| 172 per 1000 | 141 per 1000 (106 to 185) | |||||
| Incidence of relapse (evaluable participants) | Study population | OR 1.21 (0.48 to 3.03) | 802 (6 RCTs) | ⊕⊕⊝⊝ LOWa,b | Outcome measured between 15 and 56 days post‐treatment. Note: The 'evaluable participants' analysis includes only those randomised participants for whom an outcome was reported. |
|
| 44 per 1000 | 53 per 1000 (22 to 123) | |||||
| Adverse events (ITT analysis) | Study population | OR 1.19 (0.82 to 1.73) | 1727 (6 RCTs) | ⊕⊕⊝⊝ LOWa,b | A subgroup analysis based on 1 trial with 489 participants shows that children experienced more adverse events with macrolides compared with penicillin (OR 2.33, 95% CI 1.06 to 5.15). However, the test for subgroup differences was not significant. 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. |
|
| 324 per 1000 | 363 per 1000 (282 to 453) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (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. bDowngraded 1 level due to wide confidence intervals.