The Effect of Erythromycin on Resolution of Symptoms Among Adults with Pharyngitis Not Caused by Group A Streptococcus

OBJECTIVE:

To determine the effect of treatment with erythromycin on the resolution of symptoms among adults with pharyngitis not caused by group A streptococcus (GAS).

DESIGN:

Randomized, double-blind, placebo-controlled trial.

SETTING:

Ambulatory setting (hospital-based general internal medicine practices, walk-in clinic, employee health service, and university health service).

PATIENTS:

One hundred and eighty-six adults who met eligibility criteria and whose chief complaint included sore throat. Patients with positive cultures for GAS were excluded. INTERVENTION: Ninety-three patients received erythromycin (333 mg three times daily for 10 days) and 93 control patients received placebo.

MEASUREMENTS AND MAIN RESULTS:

Major outcome measurements included time to improvement in sore throat, time to improvement in cough, time to improvement in activity level, and subjective sense of well-being. The average age of the patients studied was 26.6 years; 35% were men. Patients given erythromycin had more rapid resolution of sore throat symptoms (hazard ratio 1.43; 95% confidence interval [CI] 1.00, 2.03; p = .049). Cough also resolved more rapidly in patients receiving erythromycin (hazard ratio 2.22; 95% CI 1.01, 4.88; p = .05). There were no differences between the two treatment groups in improvement of activity level or how sick patients felt in general. Most of the benefit in resolution of sore throat was conferred on patients who sought medical care within 2 days of onset.

CONCLUSIONS:

Our results suggest that the benefit of erythromycin treatment for patients with non-GAS pharyngitis is small and of borderline statistical significance. Because of the small size of the effect and because widespread use of erythromycin could promote drug resistance, we do not recommend routine use of erythromycin in adult patients with this type of pharyngitis.