Antibiotic Susceptibility Evaluation of Group A Streptococcus Isolated from Children with Pharyngitis: A Study from Iran

Abstract

BackgroundThe aim of this study was to evaluate the antibiotic susceptibility of Group A streptococcus (GAS) to antibiotics usually used in Iran for treatment of GAS pharyngitis in children.Materials and MethodsFrom 2011 to 2013, children 3-15 years of age with acute tonsillopharyngitis who attended Mofid Children's Hospital clinics and emergency ward and did not meet the exclusion criteria were enrolled in a prospective study in a sequential manner. The isolates strains from throat culture were identified as GAS by colony morphology, gram staining, beta hemolysis on blood agar, sensitivity to bacitracin, a positive pyrrolidonyl aminopeptidase (PYR) test result, and the presence of Lancefield A antigen determined by agglutination test. Antimicrobial susceptibility was identified by both disk diffusion and broth dilution methods.ResultsFrom 200 children enrolled in this study, 59 (30%) cases were culture positive for GAS. All isolates were sensitive to penicillin G. The prevalence of erythromycin, azithromycin, and clarithromycin resistance by broth dilution method was 33.9%, 57.6%, and 33.9%, respectively. Surprisingly, 8.4% of GAS strains were resistant to rifampin. In this study, 13.5% and 32.2% of the strains were resistant to clindamycin and ofloxacin, respectively.ConclusionThe high rate of resistance of GAS to some antibiotics in this study should warn physicians, especially in Iran, to use antibiotics restrictedly and logically to prevent the rising of resistance rates in future. It also seems that continuous local surveillance is necessary to achieve the best therapeutic option for GAS treatment.

Prevalence of Group A Streptococcus in Primary Care Patients and the Utility of C-Reactive Protein and Clinical Scores for Its Identification in Thailand

“…The national AMR surveillance center reported lower levels (7.2%) of erythromycin resistance in isolates from 85 hospitals across Thailand in 2018. 36 The resistance levels in our study are lower than those reported from India (46%), 37 Iran (33.9%), 33 and South Korea (25.7%), 38 similar to those from Greece (18.8%) 12 but higher than those from the United States (6.8%). 13 Reports of macrolide resistance are causing concern and limiting their use as empirical treatment for sore throats.…”

“…In our study, we found that all of our isolates were sensitive to penicillin and ceftriaxone, despite reports of ceftriaxone resistance emerging from Iran, which needs further exploration and confirmation, as historically GAS has been fully susceptible to penicillins and cephalosporins. [33][34][35] Erythromycin resistance was found in 2/11 (18.2%) GAS isolates, an important antibiotic for the treatment of pharyngitis in those with penicillin allergies. The national AMR surveillance center reported lower levels (7.2%) of erythromycin resistance in isolates from 85 hospitals across Thailand in 2018.…”

Acute Tonsillitis in Children: The Principle “Zap and It’s Done!”?

“…Лечение такого тон-зиллита подразумевает симптоматические средства -купирование болевого синдрома при его наличии, мест-нодействующие антисептики, а также снижение высокой температуры, если она есть [2]. [17][18][19]. Данное состояние также уместно назвать острым тонзиллитом, однако лечение в такой ситуации отличает-ся принципиально и последствия несвоевременного, неверного лечения достаточно серьезны.…”

“…15-30% детей и около 5-15% взрослых [17], необходимо постоянное обучение врачей, своевре-менное ознакомление их с изменениями чувствительно-сти флоры к антибиотикам и регулярный мониторинг результатов их работы [12,15,19].…”

“…Например, сообщается, что, по последним данным, в Иране устойчивость БГСА к эритромицину, азитромицину [19].…”