Is once a day amoxicillin worth the price?

Implications: A randomized and blinded study shows a once-a-day formulation of amoxicillin is non-inferior to four times a day penicillin in the treatment of pharyngitis and tonsillitis caused by Group A Beta-hemolytic streptococci. While once-a-day treatment is generally preferred over multidose treatments, will this be enough to justify the cost over generic amoxicillin, which is just pennies a dose?

Analysis: Infection cause by Group A beta hemolytic strep continues to be an important cause of visits to primary care providers. The mainstay of therapy continues to be penicillin (typically dosed four times a day) and amoxicillin (dosed three times a day). A once a day treatment regimen would undoubtedly be welcomed to ease administration.

Penicillin and amoxicillin are pennies a dose. In the era of $4 prescriptions at Wal-Mart and Target pharmacies, it may be a tough sell to convince patients and their insurers it will be worth an extra $20 or $30 to pay for the convenience of once a day dosing. While some will argue that once a day dosing is likely to encourage adherence to the regimen, thus reducing the likelihood of treatment failure and resistance that may occur with the multidose regimens, it may still be a long hill to climb.

It took many years of clarithromycin (once or twice a day) and azithromycin (once a day) to supplant erythromycin (three or four times a day) as the preferred macrolide regimen. Clari and Azithro at least had the edge of greater potency and other advantages over erythromycin, to help accelerate acceptance.