{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:49:31Z","timestamp":1782107371323,"version":"3.54.5"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Penicillin remains the first-line therapy for group A streptococcal (GAS) pharyngitis. However, broad-spectrum antibiotics continue to be widely prescribed in clinical practice. This study aimed to evaluate the relative efficacy and safety profiles of antibiotics for GAS pharyngitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Literature published through March 2026 was searched. Efficacy outcomes included early and late bacterial eradication, clinical response, and bacteriological recurrence, whereas safety was assessed according to adverse events. Per-protocol data were extracted, and a Bayesian network meta-analysis was performed to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 64 RCTs (23,287 participants). For early bacterial eradication, cefdinir (OR: 3.09; 95% CI: 1.60\u20136.01) and cefpodoxime proxetil (OR: 2.58; 95% CI: 1.07\u20136.17) demonstrated greater efficacy compared with penicillin V, whereas azithromycin showed inferior eradication rates than penicillin V (OR: 0.53; 95% CI: 0.32\u20130.90). For late bacterial eradication, cefprozil demonstrated greater efficacy compared with penicillin V (OR: 3.12; 95% CI: 1.03\u201311.25), whereas azithromycin exhibited suboptimal performance (OR: 0.38; 95% CI: 0.25\u20130.62). For early clinical response, cefdinir (OR: 2.01; 95% CI: 1.28\u20133.25) and cefuroxime axetil (OR: 2.14; 95% CI: 1.19\u20133.60) demonstrated significantly greater efficacy compared with penicillin V. For late clinical response, spiramycin showed superior efficacy to penicillin V (OR: 0.17; 95% CI: 0.02\u20130.94), although evidence was limited to a single small trial. Azithromycin was associated with reduced efficacy, higher late recurrence rates, and increased adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Standard penicillins should remain the preferred first-line therapy for GAS pharyngitis to support antimicrobial stewardship. Cefdinir represents an effective alternative. Conversely, azithromycin should be avoided due to inferior efficacy and increased adverse risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>http:\/\/www.crd.york.ac.uk\/prospero<\/jats:ext-link>\n                      , identifier CRD420251104703.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1848949","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:40:05Z","timestamp":1782106805000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of 24 antibiotics for group A streptococcal pharyngitis: a network meta-analysis of 64 randomized controlled trials"],"prefix":"10.3389","volume":"14","author":[{"given":"Xuemei","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Pediatrics, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongya","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yupeng","family":"Lei","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiechao","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bixin","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenting","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Institute of Respiratory Health and Multimorbidity, Institute of Respiratory Health, Integrated Care Management Center, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjie","family":"Ying","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruixi","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dezhi","family":"Mu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of 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