Comparison of Intravenous Co-amoxiclav and Benzyl Penicillin in Children with Severe Streptococcal Tonsillitis

Background: Streptococcal tonsillitis is a common pediatric ailment which is faced by physicians on a daily basis and is associated with disastrous complications if not treated adequately. The objective of this study was to compare the efficacy, safety and cost-effectiveness of intravenous co-amoxiclav with benzyl penicillin in the treatment of severe streptococcal tonsillitis in children. Material and Methods: This Randomized Controlled Trial was carried out at CMH Mardan, Khyber Pakhtunkhwa from January 2018 to November 2019. A total of 310 children with severe tonsillitis, aged between 5 to 15 years were selected from outpatient department of Combined Military Hospital Mardan. The cases were divided into two groups. Injection co-amoxiclav was given to patients in Group A (n=155) and injection benzyl penicillin was administered to patients in Group B (n=155). Both groups were compared in terms of effectiveness of treatment, safety and cost effectiveness. All the data was assessed with help of SPSS (Statistical Package for Social Sciences) version 21. Chi square and independent T test were used with P-value < 0.05 taken as statistically significant. Results: There were 310 children with severe tonsillitis, 155 in each group. Mean age in Group A was 9.35 ± 3.17 years and in Group B, 9.96 ± 2.96 years, respectively. In Group A, 2 cases developed hypersensitivity to injection co-amoxiclav after initial test dose as compared to 3 cases in Group B. Mean duration for complete resolution of symptoms (i.e. hospital stay) was 4.13 ± 0.375 days for Group A as compared to 4.09 ± 0.377 days for Group B (P=0.458). Mean cost of antibiotic drugs for each child in Group A was Rs. 965.88 ± 298 and in Group B was Rs. 152.36 ± 53. Benzyl penicillin was found to be significantly cost effective as compared to co-amoxiclav (P=0.000). Conclusions: Both the drugs have similar efficacy and safety profile in the treatment of severe streptococcal tonsillitis in children. However, benzyl penicillin is more cost effective than co-amoxiclav in our study population. Clinical Trail Registration: Clinicaltrials.gov: NCT0421577