Comparison of Three Antibiotics for Acute Uncomplicated Bacterial Tonsillitis, An Indian Study

Introduction

Acute tonsillitis, a common bacterial infection caused primarily by Group A beta-hemolytic Streptococci, leads to significant absenteeism and complications if untreated.

Aim

Compare the efficacy and safety of three antibiotics—co-amoxiclav (COA), cefpodoxime proxetil (CEF), and levofloxacin (LEV)—in treating acute uncomplicated bacterial tonsillitis.

Methods

• Prospective, open-label, parallel-group trial 
• N=84 divided into three treatment groups 
• Treatment Duration: 5 days

Fig: Treatment study groups and number of patients analysed

Study endpoints

Efficacy endpoints: Clinical Improvement, Bacteriological Cure

Safety Endpoints: Adverse events

Results

Clinical Improvement 

• Day 3 and 7: COA, CEF, and LEV groups showed comparable clinical responses 
• Day 5: LEV group showed a significantly reduced cure rate, but a higher improvement rate, than the COA and CEF groups

Table 1: Clinical Response Percentages Across Treatment Groups

Day	Response	Co‑amoxclav COA group (%)	Cefpodoxime CEF group (%)	Levofloxacin LEV group (%)	P value
Day 3	Improved	96.7	93.3	100	0.770
	Lost to follow‑up	3.3	6.7	0
Day 5	Cured	80	80	60	0.056
	Improved	16.7	13.3	40
	Lost to follow‑up	3.3	6.7	0
Day 7	Cured	96.7	90	93.3	0.561
	Treatment failure	0	3.3	6.7
	Lost to follow‑up	3.3	6.7	0

 

Bacteriological Cure

Responses were similar in all three groups at week one.

Table 2: Culture Results Percentages at Baseline and 1 Week 

Time Point	Culture Result	Co‑amoxclav COA group (%)	Cefpodoxime CEF group (%)	Levofloxacin LEV group (%)	P value
Baseline	Beta‑hemolytic Streptococcus	66.7	50	46.7	0.282
	S. aureus	23.3	46.7	43.3
	Gram‑positive cocci & Gram‑negative bacilli	10	3.3	10
1 Week	No growth	100	96.7	86.7	0.171
	Gram‑positive cocci	0	0	3.3
	S. aureus	0	0	3.3
	Lost to follow‑up	0	3.3	6.7

Safety

All drugs were well tolerated with a few self‑limiting adverse effects.

Conclusion

Co-amoxiclav, cefpodoxime proxetil, and levofloxacin were found to be equally effective and safe for treating acute uncomplicated bacterial tonsillitis, with minor differences in short-term response.

Reference

J Family Med Prim Care. 2024 Dec;13(12):5570-5574