Factors involved in treatment failures following oral penicillin therapy of streptococcal pharyngitis

Rosenstein, Beryl J.; Markowitz, Milton; Goldstein, Eugene O.; Kramer, Irving I.; O'Mansky, B.; Seidel, Heinz; Sigler, Arnold T.; Tramer, Arnold

doi:10.1016/s0022-3476(68)80266-5

Cited by 54 publications

(12 citation statements)

References 15 publications

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“…Recently some clinicians have noted an increased incidence of treatment failure as compared with data relating to treatment results derived 2 decades ago (6,7,(10)(11)(12)14). In view of these findings, we have evaluated antibiotic susceptibilities of group A beta-hemolytic Streptococcus strains recently isolated from patients in Oklahoma.…”

mentioning

confidence: 99%

Susceptibility of group A beta-hemolytic Streptococcus isolates to penicillin and erythromycin

Istre¹,

Welch²,

Marks³

et al. 1981

Antimicrob Agents Chemother

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We have reevaluated the antibiotic susceptibilities of group A beta-hemolytic streptococci in view of recent reports of a high prevalence of erythromycin resistance in Japan and of an increase in penicillin treatment failures in the United States. A total of 474 isolates recovered during a 2-to 3-month period in 1980 were tested. All were susceptible by microtiter broth dilution to a penicillin concentration of c0.03 ,ug/ml (minimal inhibitory concentration), and 473 were killed by c0.06 ug/ml (minimal bactericidal concentration). Erythromycin minimal inhibitory concentrations showed a bimodal distribution: 95% were -0.06,tg/ ml, and 5% were 21 ,ug/ml. Of the minimal bactericidal concentrations, 21% were 21 ,ug/ml and 3% were :16 ug/ml. Group A beta-hemolytic streptococci remain susceptible to the inhibitory and bactericidal actions of penicillin, thus providing no in vitro explanation for the bacteriological relapses reported in some clinical studies. Unlike the Japanese experience, only 5% of our isolates were resistant to erythromycin (minimal inhibitory concentration, 21 ug/ml); however, 22% were tolerant (ratio of minimal inhibitory/bactericidal concentrations, 232).Although in vitro resistance to penicillin has not been described for group A beta-hemolytic Streptococcus, a trend of increasing resistance to erythromycin has been reported (2-4, 9). Recently some clinicians have noted an increased incidence of treatment failure as compared with data relating to treatment results derived 2 decades ago (6,7,(10)(11)(12)14). In view of these findings, we have evaluated antibiotic susceptibilities of group A beta-hemolytic Streptococcus strains recently isolated from patients in Oklahoma.MATERIALS AND METHODS Group A beta-hemolytic Streptococcus isolates. Throat cultures submitted to the microbiology laboratories of Oklahoma Children's Memorial Hospital and the Oklahoma State Department of Health yielded 474 group A beta-hemolytic Streptococcus (S. pyogenes) isolates. Isolates originated, geographically, from a statewide region. Serogroup identification was based on the fluorescent-antibody technique, and hemolysis was determined by macroscopic examination of primary streak plate cultures containing 4 to 5% defibrinated sheep blood. Inocula were stabbed to facilitate detection of oxygen-labile hemolysin. Plates were incubated at 35 to 370C in an atmosphere containing 6% C02 and were examined at 24 and 48 h.Group A beta-hemolytic Streptococcus colonies were transferred to blood agar plates and maintained in pure culture at room temperature until susceptibility tests were performed. Susceptibility testing. Growth from 18-to 24-h cultures on sheep blood agar plates was adjusted to a density of approximately 10' colony-forming units per ml in Mueller-Hinton broth. A 1:10 dilution was then made in 5 ml of broth for micro-broth dilution testing, or a 1:20 dilution was made before agar dilution testing. Agar dilution tests were performed on antibiotic-supplemented Mueller-Hinton agar containing 5% sheep blood. Inoculati...

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mentioning

confidence: 99%

Susceptibility of group A beta-hemolytic Streptococcus isolates to penicillin and erythromycin

Istre¹,

Welch²,

Marks³

et al. 1981

Antimicrob Agents Chemother

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“…This difference was statistically significant. In two other studies, however, no such association could be demonstrated (13,21). Apart from demonstrating the difference in therapeutic efficacy of the two antibiotics, the epidemiological and clinical aspects of treatment failure should be considered.…”

Section: Resultsmentioning

confidence: 87%

“…Nevertheless, penicillin therapy failed in 19 % of the children treated. Rosenstein et al (13)found no correlation between the number of cases of treatment failure and detection of carriers of homologous strains in the family.…”

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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“…Symptomatic response for the acute clinical illness and prevention of acute rheumatic fever is achieved with antibiotics that can be given twice daily, including penicillin V (14,15). However, approximately every ftfth patient treated with penicillin for acute BHSGA pharyngotonsillitis continues to harbour the bacteria after treatment.…”

Section: Discussionmentioning

confidence: 99%

Cefcanel Daloxate versus Penicillin in Acute Streptococcal Pharyngotonsillitis

Grunfeld

Sinclair

Nicolle

1993

Canadian Journal of Infectious Diseases and Medical Microbiolog

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A GRUNFELD, P SINCLAIR, LE NICOLLE AND THE CANADIAN TONSILLITIS STUDY GROUP. Cefcanel daloxate versus penicillin in acute streptococcal pharyngotonsillitis. Can J Infect Dis 1994;5(3):119-124. OBJECTIVE: To de termine the efficacy, safety and tolerance of cefcanel d a loxate and ph enoxymethylpenicillin (PcV) in the trealmen l of acule ph aryngo tonsillitis caused by bela-hemolytic streptococci group A (BHSGA). PATIENTS AND METHoos: Randomized, double-blind, multicentre sludy with subjects randomized 1: 1: 1: 1 lo four parallel trealmenl groups: cefcanel daloxale 150 mg bid. 300 mg b id, 600 mg daily and PcV 300 mg tid. Patients were treated for 10 days with clinical. bacteriological and safely evaluation al inclusion . during therapy (day 5), early after completion of therapy (day 14) and lwo weeks laler (day 28) . REsULTS: Of 340 subjects enrolled, 324 were valid for safely analysis and 249 for efficacy analysis. At the short term visit, clinical cure rales for cefcanel daloxale 300 mg bid and PcV groups were s imilar al approximately 70%. The cure rates for cefcanel daloxale 150 mg bid and 600 mg daily were significantly worse at 57.4 and 54.4%. Approximately 80% of all prethempy throal swabs grew BIISGA. All BHSGA were susceptible or intermediately susceptible to PcV and cefcanel. The bacteria l elimination rate for cefcanel daloxate was 82.8% and for PcV it was 89 .8%. The elimination rate was s ignificantly lower in the cefcanel daloxate 150 mg bid and 6 00 mg daily gro u ps. The clin ical cure rates and U1e bacteriological elimination rates increased by about 10% for cefcanel daloxate 300 mg bid and the PcV groups at the lasl valid visit and rem ained s ignificantly better than tl1e other two cefcanel daloxate doses. Adverse events were not significantly different among the four treain1enl groups. CONCLUSIONs: Cefcanel daloxate 300 mg b id was as effective and as well tolerated as PcV 300 mg tid in the treatment of acute pharyngotonsillitis. A lower dose or once-daily dose regimen of cefcanel daloxate was not as effective clinically or bacleriologically. (Pour resume. voir

show abstract

Factors involved in treatment failures following oral penicillin therapy of streptococcal pharyngitis

Cited by 54 publications

References 15 publications

Susceptibility of group A beta-hemolytic Streptococcus isolates to penicillin and erythromycin

Susceptibility of group A beta-hemolytic Streptococcus isolates to penicillin and erythromycin

Cefadroxil versus penicillin in the treatment of streptococcal tonsillopharyngitis

Cefcanel Daloxate versus Penicillin in Acute Streptococcal Pharyngotonsillitis

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