Role of antibiotic therapy in the treatment of streptococcal infection

Abstract

The article states the principles for antibiotic therapy for chronic tonsillitis (CT) and acute tonsillopharyngitis (ATP). The greatest attention is paid to the non-angina CT, when the patients, as a general rule, are deprived of antibiotic therapy. At the same time, the article provides data of St. Petersburg Research Institute of ENT, whereby at least 40% of patients with CT have streptococcal etiology of the disease caused by group A beta-hemolytic streptococci (GABHS) that is confirmed by not only bacteriological, but also immunological research methods (increase in antistreptolysin-O). In addition, the number of diseases caused by groups C and G beta-hemolytic streptococci has increased in recent years. These groups of streptococci contribute to the development of complications like those caused by GABHS, and therefore the doctor’s attitude towards them should be more critical and in some respects - the same as to GABHS. As you know, streptococcal infection is one of the most dangerous due to the development of internal organs and systems complications. This proposition justifies the need for systemic antibacterial therapy in patients with CT, when they are diagnosed with streptococcal infection, regardless of the presence of angina. In vitro studies showed that GABHS has good sensitivity to penicillin preparations. However, it is not always possible to achieve treatment targets in practice. Given that the duration of antibiotic therapy for streptococcal infection should be at least 10 days, it is difficult to achieve full medication adherence. In this regard, prolonged-release penicillins, such as Bicillin-5, gain ground. The article substantiates the use of this drug in CT, discusses a clinical case, which shows the medical history of a girl with coexistent affection with GABHS of the pharynx and vagina. Only 4-month administration of Bicillin-5 allowed to cure the patient, having achieved GABH eradication.