The Treatment of the Carrier State of Group A Beta-Hemolytic Streptococci with Clindamycin

Abstract

20 children who were chronic carriers of group A beta-hemolytic streptococci (GABHS) were treated with oral clindamycin. Surface tonsillar cultures were obtained prior to therapy and 2 weeks after termination of therapy. They were processed for aerobic and anaerobic microorganisms. Mixed aerobic and anaerobic flora were obtained from all cultures. Prior to therapy, the average yield was 9 isolates (5 aerobes and 4.1 anaerobes) per specimen; after completion of therapy, the average yield was 5.7 isolates (3 aerobes and 2.7 anaerobes). GABHS, Staphylococcus aureus, Bacteroides fragilis,and Bacteroides oralis were completely eliminated after clindamycin therapy and the number of isolates of Bacteroides melaninogenicus and Fusobacterium sp. was reduced. Beta lactamase production was detected prior to therapy in 21 isolates recovered from 16 tonsillar surfaces (80%). These included all isolates of S. aureus (8) and B. fragilis (2), 8 of 18 B. melaninogenicus (44%), and 3 of 5 B. oralis (60%). Only one isolate of beta-lactamase-producing strain of B. melaninogenicus was recovered after conclusion of therapy. Follow-up of the patients for 18–24 months (average 22 months) showed no recurrence of GABHS in 19 of the 20 children.

Characterization of an Isogenic Mutant of Streptococcus pyogenes Manfredo Lacking the Ability To Make Streptococcal Acid Glycoprotein

“…It has been hypothesized that this is due to small numbers of streptococci residing inside cells, such as laryngeal cells, where penicillin is unable to penetrate and that these organisms reinitiate the infection when antibiotic treatment has finished (37,38,39). Indeed, it has been shown that treatment of patients with recurrent pharyngotonsillitis using antibiotics that are able to enter cells, for example clindamycin and rifampin, reduces the incidence of relapsing infections (8,46). Persistence of streptococcal infections may lead to increased exposure of bacterial products to the immune system and enhance the potential for developing autoimmunity.…”

Tonsil surface and core cultures in recurrent tonsillitis: Prevalence of anaerobes and beta-lactamase producing organisms

“…Several clinical studies have investigated the efficacy of different treatment regimens in the clearance of group A BHS and beta-lactamase producing aerobic and anaerobic bacteria from the oropharynx (6,28,29). The results imply that it is not sufficient to target antibiotic treatment to the suspected primary pathogen if that antibiotic is prone to inactivation by resistant organisms also likely to be present at the infected site.…”

β-Lactamase–Producing Bacteria in Upper Respiratory Tract Infections

“…This therapeutic approach has been successful in recurrent tonsillitis [26,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63]. Antimicrobials active against BLPB as well as GABHS were more effective than penicillin in the eradication of this infection.…”

“…Smith et al [26] illustrated the superiority of dicloxacillin therapy (50% success rate) compared with penicillin (17% success rate) in eradicating recurrent GABHS tonsillitis. Several studies demonstrated the efficacy of lincomycin [47][48][49][50] and clindamycin [51][52][53][54][55][56]61], the combination of penicillin plus rifampin over penicillin alone [57,58], and clindamycin over penicillin plus rifampin [59]. The superiority of these drugs compared with penicillin results from their efficacy against GABHS as well as AGNB and S. aureus.…”