Evaluation of Short-Course Therapy with Cefixime or Rifampin for Eradication of Pharyngeally Carried Group A Streptococci

Abstract

Therapy to eradicate pharyngeally carried group A streptococci (GAS) has increasingly been used in the management of institutional outbreaks and is now recommended for household contacts of patients with streptococcal toxic shock syndrome. In this randomized, controlled trial, contacts of patients with GAS infections were screened for pharyngeal GAS colonization. Those whose cultures were positive were randomized to receive either cefixime (8 mg/[kg.d]; maximum 400 mg) or rifampin (20 mg/kg; maximum, 600 mg) once a day for 4 days. Two to five days following completion of therapy, repeated cultures were negative for 13 (38%) of 34 rifampin recipients and 71 (77%; 95% CI, 69%-85%) of 97 cefixime recipients. At 10-14 days after treatment, only 53% of cefixime recipients remained culture-negative. Rates of successful clearance improved with increasing age (P < .01); among 17 adults who received cefixime, the success rate was 94%. Four days of therapy with rifampin is not effective for eradication of pharyngeally carried GAS. Four days of therapy with cefixime may be effective for adults, but further studies are needed.

Group A Streptococcus Carriage among Close Contacts of Patients with Invasive Infections

“…The questions of choice of antibiotic and duration of therapy remain to be resolved. Cephalosporins seem to be adequate in terms of efficacy, and they may be superior to rifampin, which has been shown to be a rather poor choice (19). One study evaluated the duration of antibiotic prophylaxis and found that a 4-day course may be effective if using cefixime, but data for making a firm recommendation for short term therapy are still lacking (19).…”

Flesh‐Eating Disease: A Note on Necrotizing Fasciitis

“…However, definitive studies of the benefit of chemoprophylaxis have not been conducted, and other jurisdictions suggest making decisions on a case by case basis (29). Rifampin, the usual chemotherapeutic agent for meningococcemia and Haemophilus influenzae disease, is poor at eradicating group A streptococcal carriage and is, thus, not recommended in the setting of GABHS-related NF disease (30).…”

Comparative Susceptibility of Clinical Group A, B, C, F, and G β-Hemolytic Streptococcal Isolates to 24 Antimicrobial Drugs

“…Streptococcus pyo genes reemerged as the causative agent of seri ous invasive infections, particularly necrotiz ing fasciitis and a toxic shock-like syndrome [1][2][3][4][5][6][7], In addition, there occurred a significant increase in the incidence of rheumatic fever [7][8][9], Furthermore, resistance of S. pyogenes to erythromycin, traditionally the alternative antibiotic for penicillin-allergic patients [10], increased sharply in certain geographic areas, but not in other regions [11][12][13][14][15][16][17][18][19][20], Sporadic resistance of S. pyogenes to clindamycin, con sidered to be more effective than penicillin [21][22][23] or rifampin [23,24] for the treatment of experimental myositis or for eradication of the group A streptococcal carrier state, was encountered as well [13. 25-27]; however, in other areas, S. pyogenes still was fully suscep tible to clindamycin [28,29], Currently, 5. pyogenes is considered uniformly susceptible to penicillin G and V, amoxicillin, and cepha losporins, such as cefuroxime and cefixime [24,26,27,[29][30][31]. although tolerance to pen icillin associated with altered penicillin-bind ing protein patterns (altered PBP2, increase in PBP5) had been noted in vitro [32], Since the 1970s, the role of Streptococcus agctlacliae in cases of invasive systemic infec tions in newborns acquired intra-and post partum was appreciated [33][34]…”