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Primary Care

Penicillin for acute sore throat in children: randomised, double blind trial

BMJ 2003; 327 doi: (Published 04 December 2003) Cite this as: BMJ 2003;327:1324
  1. Sjoerd Zwart, general practitioner (S.Zwart{at},
  2. Maroeska M Rovers, clinical epidemiologist,
  3. Ruut A de Melker, emeritus professor of general practice,
  4. Arno W Hoes, professor of clinical epidemiology
  1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, PO Box 85060, 3508 AB Utrecht, Netherlands
  1. Correspondence to: S Zwart
  • Accepted 21 October 2003


ObjectiveTo assess the effectiveness of penicillin for three days and treatment for seven days compared with placebo in resolving symptoms in children with sore throat.

DesignRandomised, double blind, placebo controlled trial.

Setting43 family practices in the Netherlands

Participants156 children aged 4-15 who had a sore throat for less than seven days and at least two of the four Centor criteria (history of fever, absence of cough, swollen tender anterior cervical lymph nodes, and tonsillar exudate).

InterventionsPatients were randomly assigned to penicillin for seven days, penicillin for three days followed by placebo for four days, or placebo for seven days.

Main outcome measures Duration of symptoms, mean consumption of analgesics, number of days of absence from school, occurrence of streptococcal sequelae, eradication of the initial pathogen, and recurrences of sore throat after six months.

Results Penicillin treatment was not more beneficial than placebo in resolving symptoms of sore throat, neither in the total group nor in the 96 children with group A streptococci. In the groups randomised to seven days of penicillin, three days of penicillin, or placebo, one, two, and eight children, respectively, experienced a streptococcal sequela

Conclusion Penicillin treatment had no beneficial effect in children with sore throat on the average duration of symptoms. Penicillin may, however, reduce streptococcal sequelae.


  • Contributors SZ initiated the research, designed the protocol, and collected the data. MMR analysed the data. RAdM was involved in the study design and the interpretation of data. AWH was involved in the study design and data analyses. All authors participated in writing the report. SZ will act as guarantor for the paper.

  • Funding This study was funded by Groene Land Achmea Health Insurances and the Stichting Gezondheidszorgonderzoek Ysselmond in Zwolle.

  • Competing interests None declared.

  • Ethical approval The study protocol was approved by the medical ethics committee of the Isala Clinics, Zwolle.

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