Hindawi Publishing Corporation International Journal of Pediatrics Volume 2009, Article ID 863608, 5 pages doi:10.1155/2009/863608 Clinical Study Comparative Study of 5-Day and 10-Day Cefditoren Pivoxil Treatments for Recurrent Group A β-Hemolytic Streptococcus pharyngitis in Children Hideaki Kikuta, Mutsuo Shibata, Shuji Nakata, Tatsuru Yamanaka, Hiroshi Sakata, Kouji Akizawa, and Kunihiko Kobayashi Pediatric Clinic, Touei Hospital, N-41, E-16, Higashi-ku, Sapporo 007-0841, Japan Correspondence should be addressed to Hideaki Kikuta, hide.ki@nifty.com Received 20 November 2008; Accepted 23 January 2009 Recommended by Samuel Menahem Eﬃcacy of short-course therapy with cephalosporins for treatment of group A β-hemolytic streptococcus (GABHS) pharyngitis is still controversial. Subjects were 226 children with a history of at least one episode of GABHS pharyngitis. Recurrence within the follow-up period (3 weeks after initiation of therapy) occurred in 7 of the 77 children in the 5-day treatment group and in 1 of the 149 children in the 10-day treatment group; the incidence of recurrence being signiﬁcantly higher in the 5-day treatment group. Bacteriologic treatment failure (GABHS isolation without overt pharyngitis) at follow-up culture was observed in 7 of the 77 children in the 5-day treatment group and 17 of the 149 children in the 10-day treatment group. There was no statistical diﬀerence between the two groups. A 5-day course of oral cephalosporins is not always recommended for treatment of GABHS pharyngitis in children who have repeated episodes of pharyngitis. Copyright © 2009 Hideaki Kikuta et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Introduction Group A β-hemolytic streptococci (GABHS, also referred to as Streptococcus pyogenes) are the most common bacterial cause of acute pharyngitis, accounting for approximately 15 to 30% of cases in children and 5 to 10% of cases in adults [1–3]. The objectives of treatment for GABHS pharyngitis are prevention of rheumatic fever, prevention of suppurative complications, reduction in transmission of GABHS, and shortening of the clinical course. Although the standard oral recommended therapy for GABHS pharyngitis has long been penicillin V for 10 days, there has been no change in the susceptibility of GABHS for over 50 years [1– 4]. However, recurrent GABHS infections occurred more frequently in the 1990s than the 1970s, and treatment failure rates as high as 10 to 30% have been reported [5, 6]. Reasons for failure of the standard therapy include an increase in β-lactamase-producing pharyngeal pathogens that inactivate penicillin, poor compliance, intracellular location of GABHS, eradication of protective pharyngeal α- streptococci, and increased exposure in crowded day-care centers and schools [7–9]. The increase in failure rate of the standard 10-day course of therapy with penicillin has heightened interest in alternative treatments for this infection. Cephalosporins have been used successfully for treatment of this infection since the 1970s [10, 11]. A meta-analysis showed that 10- day cephalosporin treatment was superior in eradication of GABHS and in clinical response [12]. Recent studies on the eﬃcacy of a short-course treatment (5 days) with cephalosporins compared with that of 10-day penicillin V treatment have shown that the shorter cephalosporin treatments were equivalent or superior in eradication of GABHS and in clinical response [13]. However, there are sev- eral controversial issues regarding the increase in recurrent GABHS pharyngitis since the 1990s, reasons for failure of the standard penicillin therapy and evaluation of alternative cephalosporin treatments for GABHS pharyngitis [14–16]. The purpose of this study was to determine the eﬃcacy of a 5-day course of oral cephalosporin compared with that of