Penicillin Treatment and Immunity to Scarlatina1

Abstract

Summary The effect of penicillin on immunity following scarlatina has been investigated. Comparative studies were made of the incidence of second attacks in Stockholm during the pre‐penicillin period 1938–46 and during the penicillin period 1947–51. Parallel series in addition comprised treated and untreated cases. Early second attacks, or relapses, in hospital diminished considerably due to the lesser risk of cross‐infections. The frequency of early second attacks within the first three months of recovery was, however, as great as previously. Apart from the possibility of impaired immunologic conditions during this first period, the factors governing the recurrence of attack at this stage are nowadays the risk of infection from the home environment and also, to some degree, the lack of intensity in treatment. A reduction in the early second attacks should be obtainable as a result of effective treatment and after‐control of the patients and of eradication of bacteria from the environment. As regards the late second attacks (after three months) the frequency was many times higher in 0–14 year‐old children who had been treated with penicillin than in the untreated. With increase in age, moreover, the relative frequency of second attacks rose still more. The interval between attacks was much shorter than in the pre‐penicillin period. There was thus a marked deterioration in immunity, which was all the more pronounced as the children grew older. It proved probable that the risk of a new attack of scarlatina could be diminished by postponement of treatment. This is in agreement with the observation that second attacks among penicillin‐treated desquamation cases are very much less numerous than among treated cases of scarlatina. The value of penicillin in the treatment of scarlatina is so great that its use should be continued. The tendency to second attacks, even recurring attacks, is on the other hand so considerable, at least in built‐up areas, that a modification in the treatment should be introduced. Postponed treatment can be adopted in all cases in children except those exhibiting markedly toxic symptoms or purulent complications.

Influence of penicillin treatment of horses with strangles on seropositivity to Streptococcus equi ssp. equi‐specific antibodies

“…Strikingly, by approximately 4 months after the index case (T123), fewer horses treated with penicillin earlier (Group 1) remained seropositive (Table ), suggesting a more rapid waning of humoral immunity in these animals. Similarly, studies in people have shown that early penicillin treatment of streptococcal infections may interfere with the development of humoral immunity or increase the risk of recurrence of clinical disease at a later date . A key difference between these studies in humans and the strangles outbreak described here was administration of penicillin within a few days of infection in the human patients versus a mean of 7.7 days in the horses.…”

“…When penicillin first became available to the medical profession, similar concerns about its impairment of the immune response arose. Specifically, as related to treatment of streptococcal infections in people, increased recurrence of infection was observed in human patients with scarlet fever (group A Streptococcus ) treated with penicillin particularly early after the onset of clinical disease. Later work substantiated these observations, with a suggested mechanism being that very early administration of penicillin interfered with the humoral immune response against Streptococcus .…”

Anthroposophic Perspectives in Primary Care

“…Although absolutely necessary in some situations, antibiotics do override, often prematurely, the organism's own effort to reestablish homeostasis. [30] [43] [44] This is again a picture of not allowing the host immune response to mature and strengthen fully. It is important to minimize use of antibiotics also because of their detrimental effect on normal body flora, leading to Candida overgrowth, diarrhea, digestive disturbances, and emergence of resistant organisms.…”