4 International Journal of Pediatrics Table 2: Clinical and bacteriological results. 5-day treatment group 10-day treatment group Results Recurrence (clinical treatment failure) Bacteriologic treatment failure (noneradication) Treatment failure Total 8/226 24/226 32/226 Characteristics Number of cases Male:Female Age (years) (mean±SD) Frequency of episodes (times) (mean±SD) Interval between preceding and present episodes (months) (mean±SD) 7/77 7/77 14/77 194 112 : 82 6.86 ± 2.12 2.77 ± 1.36 11.04 ± 14.57 1/149 17/149 18/149 32 26 : 6 6.24 ± 1.39 2.91 ± 1.26 7.05 ± 7.31 P value .003 .655 .231 .011 .036 .586 .018 Table 3: Characteristics of children with treatment success and treatment failure. Treatment success group Treatment failure group P value short interval between preceding and present episodes were associated with a signiﬁcantly higher risk of treatment failure including recurrence and bacteriologic treatment failure. The frequency of episodes of recurrent GABHS pharyngitis had no eﬀect on treatment failure. In comparative GABHS pharyngitis antibiotic trials, it is diﬃcult to distinguish between a GABHS carrier with an intercurrent viral infection and a patient with acute GABHS pharyngitis. Penicillin is not so eﬀective in eradication of GABHS in carriers, whereas cephalosporins are eﬀective [18]. The incidence of GABHS carriers is approximately 5 to 20% [19]. In our study, GAS carriers, if any, would have been equally distributed in the two treatment groups. Furthermore, to reduce the risk of enrolling GABHS carriers with concurrent viral pharyngitis, we excluded patients with symptoms such as rhinorrhea, cough, and conjunctivitis. The results of a previous meta-analysis indicated that 5- day or 10-day administration cephalosporins were superior to 10-day administration penicillin for treatment of GABHS pharyngitis although the results are controversial [14– 16]. There was no signiﬁcant diﬀerence between treatment failures at the follow-up visit in the cephalosporin treatment groups in our study. However, subsequent GABHS pharyn- gitis within the follow-up period occurred more frequently in the 5-day treatment group than in the 10-day treatment group. 4. Conclusion A 5-day course of oral cephalosporins is not always rec- ommended for treatment of recurrent GABHS pharyngitis in children, especially for 6- to 7-year-old boys and for children with a short interval between preceding and present episodes. Since this study has a limitation because of its nonrandomized design, further studies are necessary to determine how best to reduce treatment failure for recurrent GABHS pharyngitis in children. Acknowledgments The following clinicians participated in the study: Dr. Yasushi Akutsu, Dr. Hiroshi Sakata, Dr. Yorikazu Ishikawa, Dr. Shouichi Ishizaki, Dr. Tooru Ishioka, Dr. Youko Sakata, Dr. Shigeru Kuwajima, Dr. Mutsuko Konno, Dr. Susumu Ukae, Dr. Kazue Yasuda, Dr. Tatsuru Yamanaka, Dr. Kimihira Seki, Dr. Akira Tsuchida, Dr. Tooru Watanabe, Dr. Hideaki Kikuta, Dr. Kaname Togashi, Dr. Chie Tobise, Dr. Shuji Nakata, Dr. Naoko Nagano, Dr. Shihoko Fujisaki, Dr. Hideatsu Yoshimura, Dr. Naoki Hase, Dr. Toshiaki Hyuga, Dr. Yoshi- hiro Matsuzono, Dr. Atsushi Tame, Dr. Masahiko Mizumoto, Dr. Hideki Arioka, Dr. Mutsuo Shibata, Dr. Yoshihito Higashidate, Dr. Masayoshi Nagao, Dr. Naoki Fukushima, Dr. Koichi Yasoshima, Dr. Yoshio Hatae, Dr. Akiko Okamura, Dr. Takuji Kumagai, Dr. Masayuki Nakayama, Dr. Akio Hosoda, Dr. Takeyasu Takebayashi, Dr. Yutaka Tame, Dr. Norihiro Ueno, Dr. Akiko Kano, Dr. Mamoru Demura, Dr. Masaki Yoshida, Dr. Hironori Kojima, Dr. Masahiro Hagisawa, Dr. Hiroyuki Naito, Dr. Hiroki Tanii, Dr. Reikichi Shoji, Dr. Akira Inagawa, Dr. Haruhide Nitta, Dr. Naoki Takayanagi, Dr. Takashi Ishihara, Dr. Mayumi Sugimori, Dr. Michio Yamamoto, Dr. Kenichi Iseki, Dr. Masahiko Sugai, Dr. Michito Yoshikawa, Dr. Kazuhiro Sasaki, Dr. Hitoshi Kakehashi, Dr. Norihide Kashiwao, Dr. Katsuhiko Tanaka, Dr. Yukiteru Tachibana, Dr. Minami Yoda, and Dr. Kazunori Shinojima. The authors thank Meiji Seika Kaisha, Ltd. for ﬁnancial support and Mr. Stewart Chisholm for proofreading the manuscript. In addition, they thank Mr. Katsuichiro Ichiyama and Mr. Suguru Konishi for performing the statistical analysis. References [1] A. L. Bisno, “Acute pharyngitis,” The New England Journal of Medicine, vol. 344, no. 3, pp. 205–211, 2001. [2] C. S. Hayes and H. Williamson Jr., “Management of group A β-hemolytic streptococcal pharyngitis,” American Family Physician, vol. 63, no. 8, pp. 1557–1564, 2001. [3] A. L. Bisno, M. A. Gerber, J. M. Gwaltney Jr., E. L. Kaplan, and R. H. Schwartz, “Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis,” Clinical Infectious Diseases, vol. 35, no. 2, pp. 113–125, 2002. [4] A. Dajani, K. Taubert, P. Ferrieri, G. Peter, and S. Shulman, “Treatment of acute streptococcal pharyngitis and prevention