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

NCT ID: NCT04083417

Last Updated: 2024-12-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

260 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-09-09

Study Completion Date

2026-06-30

Brief Summary

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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.

Detailed Description

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Conditions

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Sore Throat Tonsillitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randmization to antibiotic treatment or no antibiotic treatment
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Investigators

Study Groups

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Phenoxymethylpenicillin group

Patients randomized to oral phenoxymethylpenicillin 1000 mg three times daily for ten days

Group Type ACTIVE_COMPARATOR

Phenoxymethylpenicillin

Intervention Type DRUG

tablet PcV 1000 mg x 3 for 10 days

No antibiotic treatment group

Patients randomized to no antibiotic treatment

Group Type EXPERIMENTAL

No antibiotic treatment

Intervention Type OTHER

No prescription of antibiotics

Interventions

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Phenoxymethylpenicillin

tablet PcV 1000 mg x 3 for 10 days

Intervention Type DRUG

No antibiotic treatment

No prescription of antibiotics

Intervention Type OTHER

Other Intervention Names

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Penicillin V (PcV)

Eligibility Criteria

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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.
Minimum Eligible Age

15 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Umeå University

OTHER

Sponsor Role collaborator

Linkoeping University

OTHER_GOV

Sponsor Role collaborator

Lund University

OTHER

Sponsor Role collaborator

Region Jönköping County

UNKNOWN

Sponsor Role collaborator

Katarina Hedin

OTHER_GOV

Sponsor Role lead

Responsible Party

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Katarina Hedin

Adjunct professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Katarina Hedin, Ass Prof

Role: PRINCIPAL_INVESTIGATOR

Region Jönköping County

Locations

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Vårdcentralen Rosenhälsan

Jönköping, , Sweden

Site Status RECRUITING

Vårdcentralen Kärna

Linköping, , Sweden

Site Status RECRUITING

Vårdcentralen Lundbergsgatan

Malmo, , Sweden

Site Status RECRUITING

Mariehems hälsocentral

Umeå, , Sweden

Site Status NOT_YET_RECRUITING

Ålidhems hälsocentral

Umeå, , Sweden

Site Status NOT_YET_RECRUITING

Vårdcentralen Skärvet

Vaxjo, , Sweden

Site Status RECRUITING

Countries

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Sweden

Central Contacts

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Katarina Hedin, Ass Prof

Role: CONTACT

+46761369019

Facility Contacts

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David Tell, MD

Role: primary

Anna Moberg, MD

Role: primary

Mia Tyrstrup, MD,PhD

Role: primary

Kia Ericsson, MD

Role: primary

Helena Lönneborg, MD

Role: primary

Jon Pallon, MD, PhD

Role: primary

Other Identifiers

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2019-000756-34

Identifier Type: -

Identifier Source: org_study_id