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NCT Number: NCT04083417

Sore Throat in Primary Care - a Comparison of Phenoxymethylpenicillin and No Antibiotic Treatment

Sore throat is the second most common cause of antibiotic prescribing in primary care in Sweden. Guidelines for sore throat focus on identifying people with sore throat where there are 3 and 4 specified criteria and where near patient tests identify group A streptococci (GAS). In these cases, phenoxymethylpenicillin is recommended.

Studies that have identified microorganisms in sore throat show that there are other bacteria and viruses than GAS, that give similar symptoms and that sometimes no microorganism is trapped despite pronounced symptoms. In recent years, a bacterium F. necrophorum has been identified, which is found in increased incidence of sore throat, but it is also found in healthy individuals. In clinical practice, many patients are treated with penicillin even if GAS is not captured. This may be because the doctor perceives the patient as sick or because other bacteria are not caught with a near patient test which causes the doctor to treat anyway.

The specific aims are to in patients with GAS-negative sore throat and 3 and 4 criteria, aged 15 years and older in primary care, study whether phenoxymethylpenicillin treatment shortens the duration of the disease, reduces the symptom intensity and sickness absence, and investigates the importance of other microorganisms than GAS in sore throat.

The study is a randomized controlled trial in which patients with sore throat are randomized to phenoxymethylpenicillin 3 times daily for 10 days or to no antibiotic therapy. There will also be and a reference group with severe (Centor score 3-4), GAS-positive acute tonsillitis.

Blood samples for inflammatory and immunological response to infections are taken. Throat samples for culture of F. necrophorum and streptococcal groups C and G, as well as polymerase chain reaction (PCR) analysis for bacteria and viruses are also taken at inclusion and at follow-up.

The outcome will be followed in a patient diary for 10 days and at a return visit after 18-24 days where the clinical outcome is asked for and where the blood- and throat samples are repeated.

Follow-up will also takes place via e-mail after 1 and 3 months.

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Key information

Conditions

Sore Throat Infections Otorhinolaryngologic Diseases Pharyngeal Diseases Pharyngitis Respiratory Tract Diseases Respiratory Tract Infections Stomatognathic Diseases Tonsillitis

Age range

15 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 4

Primary location

Vårdcentralen Rosenhälsan, Jönköping, Sweden

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Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

' Centor score 3-4: absence of cough, anamnestic fever (temperature >38.5°C), tender cervical lymphadenitis, and tonsillar exudates (one or both tonsils)

  • Duration of symptoms < 8 days
  • Rapid antigen detection test for GAS taken and negative
  • Willing and able to give informed consent. Subjects under 18 years of age must in addition have the consent from both parents/caretakers

Exclusion criteria

  • Ongoing antibiotic treatment
  • Known or suspected allergies to phenoxymethylpenicillin
  • Suspicion of peritonsillar abscess or indication for admittance.

Treatment and study plan

Phenoxymethylpenicillin

Drug

tablet PcV 1000 mg x 3 for 10 days

Other names: Penicillin V (PcV)

No antibiotic treatment

Other

No prescription of antibiotics

Primary outcomes

  1. Differences in number of days from inclusion to resolution of symptoms

    Time frame: 10 days after inclusion

    Differences between the randomized groups. Symptom resolution is defined as the first day the item sore throat and difficulty swallowing is scored less than moderately bad

Secondary outcomes

  1. Proportions of patients with symptom resolution at each of the days 2 through 10.

    Time frame: up to 10 days after inclusion

  2. The number of days from inclusion to symptom resolution of the individual items of sore throat symptoms.

    Time frame: 10 days after inclusion

  3. Differences in number of days from inclusion to the day the patient can put up with the pain.

    Time frame: up to 10 days after inclusion

  4. The possible change in the self-reported items of symptoms on the rating scale for each of the days 2 through 10 and describe the break through day for improvement

    Time frame: up to between 10 days after inclusion

    The rating is on a 7-point Likert scale 0=no symptoms, 1= very little, 2=slight, 3=moderately bad, 4=bad, 5=very bad, 6=as bad as it could be.

  5. The number of days the patient needs to stay at home from work/school

    Time frame: 10 days after inclusion

  6. Proportion of patients with future episodes of sore throat

    Time frame: 30 days and 3 months after inclusion

  7. Proportion of patients at follow up with eradication of each of the potential pathogens found.

    Time frame: between 18 up to 24 days

    Bacteriological eradication

  8. The number of adverse events

    Time frame: 3 months after inclusion

  9. Description of patient characteristics and outcomes in the drop-out group.

    Time frame: 3 months

Study contacts

Contact information is provided by the study sponsor or research team.

Katarina Hedin, Ass Prof

CONTACT

[email protected]

+46761369019

Sponsors and collaborators

Lead sponsor

Katarina Hedin

Other Gov

Collaborators

  • Linkoeping University
  • Lund University
  • Region Jönköping County
  • Umeå University

Registry information

Official study title

A Randomized Controlled Clinical Trial of Streptococcus Group A-negative Acute Tonsillitis in Primary Health Care - a Comparison of Phenoxymethylpenicillin and No Antibiotic Treatment

Acronym: SANT

Important dates

Study start
2019
Primary completion
2026
Study completion
2026
First posted
Sep 10, 2019
Registry last updated
Dec 4, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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