Efficacy of benzathine penicillin G in group A streptococcal pharyngitis: Reevaluation

Feldman, Sandor; Bisno, Alan L.; Lott, Lennie; Dodge, Richard K.; Jackson, Rachel E.

doi:10.1016/s0022-3476(87)80024-0

Cited by 40 publications

(13 citation statements)

References 19 publications

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“…The term penicillin tolerance is clearly defined, however the methodical procedure is not standardized. Thus, in our study we could not detect one single penicillin tolerant strain, which corresponds to the findings of Str6mberg (9) and Feldmann et al (18). It seems doubtful that the lack of success of therapy can be attributed to penicillin tolerance.…”

Section: Resultssupporting

confidence: 83%

Cefadroxil versus penicillin in the treatment of streptococcal tonsillopharyngitis

Milatovic

Knauer

1989

Eur. J. Clin. Microbiol. Infect. Dis.

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In a randomized multicentre study the efficacy of phenoxymethyl-penicillin and cefadroxil was tested in the treatment of acute tonsillopharyngitis caused by group A streptococci. These organisms were detected in 269 of the 300 children studied. Of the 239 patients in whom results could be evaluated, 121 received penicillin and 118 cefadroxil. After ten days of therapy the microbiological failure rate was 19% in the penicillin group and 6.8% in the cefadroxil group (p less than 0.01). Ten of 23 cases of microbiological failure in the penicillin group and two of eight in the cefadroxil group also had clinical symptoms of infection. All streptococcal isolates were sensitive to penicillin, cefadroxil and clindamycin with the exception of one strain with intermediate sensitivity to cefadroxil. Seven strains had intermediate sensitivity to erythromycin and one was resistant. No penicillin tolerance was observed. Patients in whom penicillin therapy failed more frequently had beta-lactamase producing staphylococci in the pharyngeal flora in comparison to successfully treated patients. The clinical and bacteriological results showed that cefadroxil was clearly superior to penicillin.

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Section: Resultssupporting

confidence: 83%

Cefadroxil versus penicillin in the treatment of streptococcal tonsillopharyngitis

Milatovic

Knauer

1989

Eur. J. Clin. Microbiol. Infect. Dis.

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“…However, streptococcal pharyngitis classically is not a reportable disease, and it has been speculated that the documented number of these pharyngitis cases may be considerably underestimated. Additionally, penicillin fails to completely eradicate streptococci in up to 35% of patients treated for pharyngitis (3), and carriage rates as high as 50% have been reported in close contact areas such as day care centers (4). This high carriage rate contributes to the spread of streptococcal pharyngitis (5) and correlates with outbreaks of rheumatic fever (6).…”

mentioning

confidence: 99%

Prevention and elimination of upper respiratory colonization of mice by group A streptococci by using a bacteriophage lytic enzyme

Nelson

Loomis²,

Fischetti³

2001

Proc. Natl. Acad. Sci. U.S.A.

480

415

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Bacteriophage lytic enzymes quickly destroy the cell wall of the host bacterium to release progeny phage. Because such lytic enzymes specifically kill the species in which they were produced, they may represent an effective way to control pathogenic bacteria without disturbing normal microflora. In this report, we studied a murein hydrolase from the streptococcal bacteriophage C 1 termed lysin. This enzyme is specific for groups A, C, and E streptococci, with little or no activity toward several oral streptococci or other commensal organisms tested. Using purified lysin in vitro, we show that 1,000 units (10 ng) of enzyme is sufficient to sterilize a culture of Ϸ10 7 group A streptococci within 5 seconds. When a single dose of lysin (250 units) is first added to the oral cavity of mice, followed by 10 7 live group A streptococci, it provides protection from colonization (28.5% infected, n ‫؍‬ 21) compared with controls without lysin (70.5% infected, n ‫؍‬ 17) (P < 0.03). Furthermore, when lysin (500 units) was given orally to 9 heavily colonized mice, no detectable streptococci were observed 2 h after lysin treatment. In all, these studies show that lysin represents a unique murein hydrolase that has a rapid lethal effect both in vitro and in vivo on group A streptococci, without affecting other indigenous microorganisms analyzed. This general approach may be used to either eliminate or reduce streptococci from the upper respiratory mucosal epithelium of either carriers or infected individuals, thus reducing associated disease.

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“…If our conjectures are correct then penicillin tolerance may reflect the mode of transmission and/or previous administration of antibiotics. The role of penicilfin-tolerant group A streptococci in the severity of pharyngitis and in failure of treatment is still controversial, some investigators suggesting a causative role (5, 6) while others found no such relationship (7,8). Although in the present report the epidemics associated with penicillin tolerant group A streptococci persisted longer than those caused by nontolerant strains, it is difficult to draw any conclusions since the modes of transmission and populations were entirely different.…”

Section: Remits and Discussionmentioning

confidence: 53%

Association of penicillin-tolerant streptococci with epidemics of streptococcal pharyngitis in closed communities

Dagan

Ferne

1989

Eur. J. Clin. Microbiol. Infect. Dis.

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The association of penicillin-tolerant streptococci with reported epidemics of streptococcal pharyngitis in Israel was studied. The streptococcal strains had been isolated during 11 epidemics of community-acquired pharyngitis and 6 food-borne epidemics of pharyngitis occurring in the last 15 years. Strains were stocked lyophilized. Isolates were defined as tolerant if the MBC/MIC ratio for penicillin was greater than or equal to 32. All 122 group A streptococcal strains isolated during the epidemics of community-acquired infection showed tolerance to penicillin. In contrast, none of the 52 strains from food-borne epidemics (24 group A, 18 group C and 8 group G) was tolerant.

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Efficacy of benzathine penicillin G in group A streptococcal pharyngitis: Reevaluation

Cited by 40 publications

References 19 publications

Cefadroxil versus penicillin in the treatment of streptococcal tonsillopharyngitis

Cefadroxil versus penicillin in the treatment of streptococcal tonsillopharyngitis

Prevention and elimination of upper respiratory colonization of mice by group A streptococci by using a bacteriophage lytic enzyme

Association of penicillin-tolerant streptococci with epidemics of streptococcal pharyngitis in closed communities

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