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Treatment of Group A Beta Hemolytic Streptococcal Pharyngitis in Children in Low Resource Settings (TOPS)

This study has been completed.
United States Agency for International Development (USAID)
World Health Organization
Cairo University
University Hospital for Infectious Diseases, Croatia
Universidade Federal do Rio de Janeiro
Information provided by:
Johns Hopkins University Identifier:
First received: July 2, 2010
Last updated: NA
Last verified: December 2009
History: No changes posted
The purpose of this study was to compare the microbiological effects of two different treatments: a single dose of intramuscular benzathine penicillin G (IM BPG) vs. a 10-day daily dose of amoxicillin for the treatment of GABHS pharyngitis in children in low resource settings. This study was a prospective multi-center randomized active control treatment trial. The trial is a non-inferiority equivalence trial, to determine if amoxicillin treatment is at least as effective as the currently given IM BPG treatment.

Condition Intervention
Streptococcal Infections
Drug: Penicillin G, Benzathine
Drug: Amoxicillin

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Treatment of Pharyngitis Study (TOPS): A Randomized Equivalence Trial of Intramuscular Penicillin G vs. Oral Amoxicillin Antibiotics for the Treatment of Streptococcal Pharyngitis in Children in Developing Countries

Resource links provided by NLM:

Further study details as provided by Johns Hopkins University:

Primary Outcome Measures:
  • Eradication of Group A Streptococcus (GAS) [ Time Frame: 21-28 days after 1st visit ]
    The primary outcome of the study was bacteriologic treatment success, which was defined as eradication of GAS from the pharynx at the follow up visit. Eradication was defined as no GAS present on the throat culture.

Secondary Outcome Measures:
  • Compliance to treatment [ Time Frame: 21-28 days after 1st visit ]
    Compliance with the amoxicillin treatment regimen was assessed at the follow up visit. The primary measure of compliance was the presence of antimicrobial activity in the urine-impregnated filter paper strips. For those who did not return the filter paper strip, compliance was measured by parent/guardian report during the exit interview. Patients who did not fulfill at least one of these criteria were considered noncompliant.

Enrollment: 558
Study Start Date: August 2001
Study Completion Date: April 2003
Primary Completion Date: April 2003 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Intramuscular benzathine Penicillin G
A single dose of intramuscularly administered intramuscular benzathine penicillin G (IM BPG). The dosing was as follows: IM BPG; 600,000 U > 27kg or 1,200,000 U <27 kg
Drug: Penicillin G, Benzathine
IM BPG; 600,000 U > 27kg or 1,200,000 U <27 kg)
Other Names:
  • Intramuscular Benzathine Penicillin G
  • Beta-lactam antibiotics
Active Comparator: Amoxicillin
A 10-day once daily dose of Amoxicillin was given in an oral form. The first dose was given at the time of randomization, and parents were instructed on giving the remaining doses. Dosing was as follows: 750 mg/QD
Drug: Amoxicillin
750 mg/QD
Other Names:
  • Amoxil®
  • Trimox®


Ages Eligible for Study:   2 Years to 12 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age: 2-12 years old,
  • Presenting with complaint of sore throat
  • Parental consent given and child assent if 5 years or older

Exclusion Criteria:

  • The parent/guardian reported oral antibiotic use in the past 3 days or injectable penicillin in past 28 days prior to screening
  • Had a history of rheumatic fever or rheumatic heart disease
  • Required hospitalization for any reason at the time of enrollment
  • Had previously been enrolled in the study
  Contacts and Locations
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Please refer to this study by its identifier: NCT01156740

Federal University of Rio de Janeiro
Rio de Janeiro, Brazil
University Hospital for Infectious Diseases
Zagreb, Croatia
Cairo University
Cairo, Egypt
Sponsors and Collaborators
Johns Hopkins University
United States Agency for International Development (USAID)
World Health Organization
Cairo University
University Hospital for Infectious Diseases, Croatia
Universidade Federal do Rio de Janeiro
Principal Investigator: Mark C. Steinhoff, MD Johns Hopkins Bloomberg School of Public Health
  More Information

Responsible Party: Dr. Mark C. Steinhoff, Cincinnati Children's Hospital / Johns Hopkins Bloomberg School of Public Health Identifier: NCT01156740     History of Changes
Other Study ID Numbers: HRN-A-00-96-90006-00
Study First Received: July 2, 2010
Last Updated: July 2, 2010

Keywords provided by Johns Hopkins University:
streptococcal pharyngitis
randomized clinical trial
intramuscular benzathine penicillin G.

Additional relevant MeSH terms:
Streptococcal Infections
Gram-Positive Bacterial Infections
Bacterial Infections
Pharyngeal Diseases
Stomatognathic Diseases
Respiratory Tract Infections
Respiratory Tract Diseases
Otorhinolaryngologic Diseases
Anti-Bacterial Agents
Penicillin G
Penicillin G Benzathine
Penicillin G Procaine
Antibiotics, Antitubercular
Anti-Infective Agents
Antitubercular Agents processed this record on May 25, 2017