Eradication of the group A β-hemolytic streptococci from the tonsillopharynx by use of antibiotics is the essential outcome to prevent suppurative and nonsuppurative sequelae, abate symptoms, and prevent contagion. The minimum criterion standard for eradication rate is 85% or better according to the United States Food and Drug Administration. From 1991 to present less than 20% of clinical trials have shown penicillin to meet or exceed the minimum standard compared with 100% for various cephalosporins, amoxicillin/clavulanate, and macrolides/azalides, when appropriately dosed. Efficacy alone cannot produce optimal treatment outcomes in clinical practice because nonadherence frequently results in failed therapy, persistence of infection, and morbidity. Poor taste and the need for 10 days of therapy with penicillin are adherence barriers. The evidence base supporting the selection of cephalosporins in preference to penicillin for treatment of group A β-hemolytic streptococci tonsillopharyngitis is very strong (type A), and these agents have a better tolerability and adherence profile.
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