Treatment of Patients with a History of Recurrent Tonsillitis Due to Group A Beta-hemolytic Streptococci

Brook, Itzhak; Hirokawa, Ronald H.

doi:10.1177/000992288502400606

Cited by 99 publications

(14 citation statements)

References 13 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Mitchelmore

Reilly

Hay

et al. 1994

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

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The bacterial flora of the tonsil surface and core was compared in patients suffering from recurrent tonsillitis. Surface swabs and tonsil core tissues were received as paired samples from 50 patients admitted for elective tonsillectomy. Analysis of paired samples from individual patients revealed differences in the bacterial flora of the tonsil core and the tonsil surface. Of 366 aerobic isolates, 30% grew from the surface alone, 26% from the core only and 44% from both sites. Of 290 anaerobic isolates, 35% grew from the surface alone, 33% from the core only and 31% from both sites. The total number of isolates from surface and core samples was similar (average 9.2 and 8.8, respectively). The range of species isolated was also similar for both surface and core samples, as was the proportion of organisms producing beta-lactamase from each site (10.7% and 9.5%, respectively). Eighty-two percent of patients carried beta-lactamase-producing organisms on either the tonsil surface or in the core tissue. A surface swab does not reliably reflect the types of organisms present in the tonsil core in individual patients. Anaerobes are a major component of tonsil surface and core bacterial flora in patients with recurrent tonsillitis. The high carriage rate of beta-lactamase-producing organisms in the tonsils should be considered when selecting antimicrobial therapy for persistent or recurrent tonsillitis.

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Section: Discussionmentioning

confidence: 99%

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

Mitchelmore

Reilly

Hay

et al. 1994

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

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“…The recovery of aerobic and anaerobic BLPB in over three-fourths of the patients with recurrent GABHS tonsillitis (6,19,23), the ability to measure P-lactamase activity in the core of their tonsils (5), and their responses to antimicrobial agents that are effective against BLPB (2,13) support the role of these organisms in the inability of penicillin to eradicate GABHS from patients with recurrent tonsillitis.…”

Section: Discussionmentioning

confidence: 92%

Evaluation of bacterial interference and beta-lactamase production in management of experimental infection with group A beta-hemolytic streptococci

Brook

Gilmore

1993

Antimicrob Agents Chemother

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The in vivo effects of penicillin and cefprozil therapy on the interaction between organisms commonly recovered from inflamed tonsils were studied by using a subcutaneous abscess model in mice. These organisms were group A beta-hemolytic streptococci (GABHS), Streptococcus salivarius (which is capable of interfering with GABHS), and Staphylococcus aureus. In mice infected with GABHS and S. salivarius alone or in combination, penicillin eliminated both organisms and cefprozil eliminated GABHS and S. aureus but not S. salivarius. Penicillin did not, however, reduce the number of GABHS or S. salivarius in the presence of S.aureus. The present study demonstrated the ability of 1-lactamase-producing S. aureus to protect GABHS from penicillin. However, no such protection was present following the administration of cefprozil. Furthermore, the preservation of S. salivarius that interferes with GABHS growth may provide protection from reinfection with GABHS. This study supports and provides an explanation for the increased efficacies of cephalosporins administered orally over that of penicillin when treating patients with acute GABHS pharyngitis or tonsillitis.

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“…On the other hand, in eight cases of failure of penicillin therapy the patients could be treated successfully with cefadroxil in a second course of therapy and similarly one patient was treated successfully with clindamycin. Although clindamycin has been shown in various studies to have good activity (12,30,31) it cannot be widely used due to side effects.…”

Section: Resultsmentioning

confidence: 99%

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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Treatment of Patients with a History of Recurrent Tonsillitis Due to Group A Beta-hemolytic Streptococci

Cited by 99 publications

References 13 publications

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

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

Evaluation of bacterial interference and beta-lactamase production in management of experimental infection with group A beta-hemolytic streptococci

Cefadroxil versus penicillin in the treatment of streptococcal tonsillopharyngitis

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