Forty-five patients with a history of recurrent tonsillitis associated with Group A beta-hemolytic streptococcal (GABHS) infection participated in a prospective, randomized study comparing penicillin, erythromycin, or clindamycin therapy. Surface tonsillar cultures were obtained before therapy, 10 days after termination of therapy, and once a month for a period of 12 to 18 months. The specimens were processed for aerobic and anaerobic bacteria. Beta lactamase-producing aerobic and anaerobic bacteria were present in 43 of the 45 (96%) tonsillar cultures. GABHS colonization was eradicated in two of 15 patients treated with penicillin, in six of 15 treated with erythromycin, and in 14 of the 15 treated with clindamycin. In long-term follow-up, 12 of 14 patients treated with penicillin, eight of 14 treated with erythromycin, and one of 15 treated with clindamycin (p less than 0.0001 when compared to penicillin and p = 0.002 when compared to erythromycin) continued to suffer from recurrent tonsillitis.
Specimens of pus were obtained from 24 patients who developed postoperative wound infection after head and neck cancer surgery. Aerobic bacteria only were isolated in two instances (8%), anaerobic bacteria only in one (4%), and mixed aerobic and anaerobic bacteria in 21 (88%). A total of 146 isolates were recovered (66 aerobic and 80 anaerobic), an average of six isolates per specimen (2.7 aerobic and 3.3 anaerobic). The most frequently recovered isolates were Peptostreptococcus sp, Staphylococcus aureus, Bacteroides sp, Fusobacterium, and enteric gram-negative rods. Twenty-two isolates recovered from 17 wounds (71%) produced beta-lactamase. These included all five isolates of S aureus and nine of 17 (53%) of the Bacteroides melaninogenicus group. The polymicrobial aerobic/anaerobic nature of postoperative wound infections after head and neck cancer surgery and the presence of beta-lactamase-producing bacteria may have important implications for the management of these infections.
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