Comparison of oral cephalosporins with penicillin therapy for Group A streptococcal pharyngitis

Antibiotic Susceptibility of Streptococcus Pyogenes Strains Isolated From Throat Cultures of Children With Tonsillopharyngitis

“…We also could not determine any S. pyogenes strain tolerant to penicillin G. Penicillin G MIC and MBC values of S. pyogenes were similar in our study. Penicillin failure in streptococcal tonsillopharyngitis reported as 10-25% (18,19). Some authors blamed penicillin tolerance in patients with penicillin failure (20,21).…”

Comparative efficacy and safety of cefprozil (BMY-28100) and cefaclor in the treatment of acute group A beta-hemolytic streptococcal pharyngitis

“…Although these adverse events were more common in the cefprozil-treated group, they did not reach statistical significance (nausea, P = 0.21; leukopenia, P = 0.14). (8,14). P-lactamase-producing microflora such as S. aureus, H. influenzae, H. parainfluenzae, M. catarrhalis, and anaerobic bacteria in the oropharynx have been suggested as possible causes of such treatment failures (3,9).…”

“…Results of previous attempts to decrease GABHS persistence by treating patients with oral narrow-spectrum cephalosporins have been inconsistent. However, trials with cefaclor have demonstrated statistically significant decreased failure rates when compared with penicillin (12,14). Since in vitro data indicate that susceptibility of common pediatric pathogens to cefprozil is superior to that of cefaclor (4,5,9), cefprozil may be of benefit in the management of these infections.…”

“…Recent reports have documented high failure rates in some patients treated with penicillin for group A streptococcal pharyngitis (3,8,14). The inability to eradicate group A streptococci may be due to a residual or recurrent infection; the persistence of a carrier state may be due to the presence of ,B-lactamase-producing aerobic and anaerobic bacteria in the oropharynx (3,9).…”

“…The inability to eradicate group A streptococci may be due to a residual or recurrent infection; the persistence of a carrier state may be due to the presence of ,B-lactamase-producing aerobic and anaerobic bacteria in the oropharynx (3,9). Clinical trials with ,B-lactamase stable compounds and anti-anaerobe agents have been found to be more effective in eradicating the carrier state and preventing recurrent infection (3,9,14). Cefprozil, with its stability to hydrolysis by plasmid-mediated P-lactamase enzymes, may be a good drug to evaluate under this assumption (4,7).…”