Penicillin V, loracarbef and clindamycin in tonsillar surface fluid during acute group A streptococcal pharyngotonsillitis

Orrling, Arne; Kamme, Carl; Stjernquist-Desatnik, Anna

doi:10.1080/00365540410020947

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…On the tenth day of treatment, penicillin was present in the tonsillar surface fluid of only one patient and was not present in the saliva of any patient. Orrling and coleagues, demonstrated that a cephalosporin (loracarbef) and clindamycin maintained higher concentration in tonsillar surface fluid for longer duration than penicillin [14].…”

Section: Intracellular Survival Of Gabhs Due To the Inadequate Penetrmentioning

confidence: 99%

Penicillin failure in the treatment of group A streptococcal pharyngo-tonsillitis: Causes and solutions

Brook

2015

J Pediatr Infect Dis

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Despite its in vitro efficacy, the increased inability of penicillin to eradicate Group A beta-hemolytic streptococci (GABHS) from patients with acute and relapsing pharyngo-tonsillitis (PT) is of great concern. This review describes the causes of penicillin failure in eradicating GABHS PT. These include the presence of beta-lactamase producing bacteria (BLPB) that "protect" GABHS from penicillins; the absence of bacteria that interfere with the growth of GABHS; co-aggregation between GABHS and Moraxella catarrhalis; and the poor penetration of penicillin into the tonsillar tissues and the tonsillo-pharyngeal cells which allows intracellular GABHS and Staphylococcus aureus to survive. The inadequate intracellular penetration of penicillns can allow intracellular GABHS and S. aureus to persist. In the treatment of acute tonsillitis, the use of cephalosporins can overcome these interactions by eradicating aerobic BLPB (including M. catarrhalis), while preserving the potentially interfering organisms and eliminating GABHS. In treatment of recurrent and chronic PT the administration of clindamycin, or amoxicillin-clavulanic acid can eradicate both aerobic and anaerobic BLPB as well as GABHS. The superior intracellular penetration of cephalosporins and clindamycin enhances their efficacy against intracellular GABHS and S. aureus.

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Section: Intracellular Survival Of Gabhs Due To the Inadequate Penetrmentioning

confidence: 99%

Penicillin failure in the treatment of group A streptococcal pharyngo-tonsillitis: Causes and solutions

Brook

2015

J Pediatr Infect Dis

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“…On the tenth day of treatment, penicillin was present in the tonsillar surface fluid of only one patient and was not present in the saliva of any patient. Orrling et al 13 demonstrated that cephalosporin (loracarbef) and clindamycin maintained higher concentration in tonsillar surface fluid for a longer duration than penicillin. …”

Section: Causes Of Penicillin Failure In Eradicating Gabhs Ptmentioning

confidence: 99%

Treatment Challenges of Group A Beta-hemolytic Streptococcal Pharyngo-Tonsillitis

Brook

2016

Int Arch Otorhinolaryngol

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Introduction Despite its in vitro efficacy, penicillin often fails to eradicate Group A β-hemolytic streptococci (GABHS) from patients with acute and relapsing pharyngo-tonsillitis (PT). Objective This review of the literature details the causes of penicillin failure to eradicate GABHS PT and the therapeutic modalities to reduce and overcome antimicrobial failure. Data Synthesis The causes of penicillin failure in eradicating GABHS PT include the presence of β lactamase producing bacteria (BLPB) that “protect” GABHS from any penicillin; the absence of bacteria that interfere with the growth of GABHS; co-aggregation between GABHS and Moraxella catarrhalis; and the poor penetration of penicillin into the tonsillar tissues and the tonsillo-pharyngeal cells, which allows intracellular GABHS and Staphylococcus aureus to survive. The inadequate intracellular penetration of penicillin can allow intracellular GABHS and S. aureus to persist. In the treatment of acute tonsillitis, the use of cephalosporin can overcome these interactions by eradicating aerobic BLPB (including M. catarrhalis), while preserving the potentially interfering organisms and eliminating GABHS. Conclusion In treatment of recurrent and chronic PT, the administration of clindamycin, or amoxicillin-clavulanic acid, can eradicate both aerobic and anaerobic BLPB, as well as GABHS. The superior intracellular penetration of cephalosporin and clindamycin also enhances their efficacy against intracellular GABHS and S. aureus.

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“…A correlation with leukocytosis (33, 71) or an increased level of C‐reactive protein and beta‐hemolytic group A streptococcal pharyngotonsillitis has been reported (40), whereas other investigators have failed to verify such relationships (61, 70). Serological tests of anti‐streptolysin O and anti‐DNase B are of no diagnostic value in acute pharyngotonsillitis, but may be useful in the investigation of complications of the disease, such as rheumatic fever (69).…”

Section: Beta‐hemolyic Group a Streptococcimentioning

confidence: 99%

“…Treatment of recurrent beta‐hemolytic group A streptococcal pharyngotonsillitis with clindamycin instead of penicillin V seems to produce a significantly better clinical outcome (6, 62). This may be a result of the intracellular accumulation and a high concentration of clindamycin in tonsillar surface fluid (61).…”

Section: Beta‐hemolyic Group a Streptococcimentioning

confidence: 99%

Pharyngotonsillitis

Stjernquist-Desatnik¹,

Orrling²

2008

Periodontology 2000

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Penicillin V, loracarbef and clindamycin in tonsillar surface fluid during acute group A streptococcal pharyngotonsillitis

Cited by 9 publications

References 29 publications

Penicillin failure in the treatment of group A streptococcal pharyngo-tonsillitis: Causes and solutions

Penicillin failure in the treatment of group A streptococcal pharyngo-tonsillitis: Causes and solutions

Treatment Challenges of Group A Beta-hemolytic Streptococcal Pharyngo-Tonsillitis

Pharyngotonsillitis

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