Treatment of streptococcal pharyngotonsillitis: Reports of penicillin's demise are premature

Markowitz, Milton; Gerber, Michael A.; Kaplan, Edward L.

doi:10.1016/s0022-3476(05)80840-6

Cited by 93 publications

(32 citation statements)

References 58 publications

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“…The most direct evidence that intracellular invasion is more than a laboratory phenomenon comes from studies of patients with recurrent tonsillitis. Failure to eradicate streptococci from the throat in pharyngotonsillitis occurs in approximately 30% of cases (348,421). Osterlund and colleagues showed that tonsils excised from such individuals harbored intracellular group A streptococci (403).…”

Section: Intracellular Invasionmentioning

confidence: 99%

Pathogenesis of Group A Streptococcal Infections

Cunningham

2000

Clinical Microbiology Reviews

1,607

1,337

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Section: Intracellular Invasionmentioning

confidence: 99%

Pathogenesis of Group A Streptococcal Infections

Cunningham

2000

Clinical Microbiology Reviews

1,607

1,337

View full text Add to dashboard Cite

“…Many patients in whom treatment fails are chronic carriers who have prolonged periods of GAS colonization. 63 A second course of therapy in asymptomatic individuals should be considered only for those with previous rheumatic fever themselves or in members of their families. Symptomatic individuals who continue to harbor GAS in their pharynx after completion of a course of therapy can be retreated with the same antimicrobial agent, given an alternative oral agent, or given an intramuscular dose of benzathine penicillin G, especially if poor adherence to oral therapy is likely; however, expert opinions differ about the most appropriate therapy in this situation (Class II, LOE C).…”

Section: Treatment Failuresmentioning

confidence: 99%

Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis

Gerber¹,

et al. 2009

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Abstract-Primary prevention of acute rheumatic fever is accomplished by proper identification and adequate antibiotic treatment of group A ␤-hemolytic streptococcal (GAS) tonsillopharyngitis. Diagnosis of GAS pharyngitis is best accomplished by combining clinical judgment with diagnostic test results, the criterion standard of which is the throat culture. Penicillin (either oral penicillin V or injectable benzathine penicillin) is the treatment of choice, because it is cost-effective, has a narrow spectrum of activity, and has long-standing proven efficacy, and GAS resistant to penicillin have not been documented. For penicillin-allergic individuals, acceptable alternatives include a narrow-spectrum oral cephalosporin, oral clindamycin, or various oral macrolides or azalides. The individual who has had an attack of rheumatic fever is at very high risk of developing recurrences after subsequent GAS pharyngitis and needs continuous antimicrobial prophylaxis to prevent such recurrences (secondary prevention). The recommended duration of prophylaxis depends on the number of previous attacks, the time elapsed since the last attack, the risk of exposure to GAS infections, the age of the patient, and the presence or absence of cardiac involvement. Penicillin is again the agent of choice for secondary prophylaxis, but sulfadiazine or a macrolide or azalide are acceptable alternatives in penicillin-allergic individuals. This report updates the 1995 statement by the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee. It includes new recommendations for the diagnosis and treatment of GAS pharyngitis, as well as for the secondary prevention of rheumatic fever, and classifies the strength of the recommendations and level of evidence supporting them. (Circulation. 2009;119:1541-1551.)

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“…5 Isolation of a penicillin-resistant strain of GABHS has yet to occur. 6 Newer antibiotics such as cephalosporins and macrolides, although possessing at least equal efficacy and more convenient dosing, have been associated with higher costs as well as the worrisome problem of increased antibiotic resistance attributable to their wider spectrum of activity than that of penicillin.…”

Section: G Roup a ␤-Hemolytic Streptococcus (Gabhs)mentioning

confidence: 99%

The Impact of Dosing Frequency on the Efficacy of 10-Day Penicillin or Amoxicillin Therapy for Streptococcal Tonsillopharyngitis: A Meta-analysis

Lan

Colford²

2000

Pediatrics

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ABSTRACT. Objective. The recommended dosing frequency of oral penicillin for the treatment of acute streptococcal tonsillopharyngitis has long been 3 to 4 times daily. In 1994, treatment guidelines included twicedaily (BID) dosing for the first time, a recommendation that could significantly increase the ease of compliance. This meta-analysis was performed to determine whether overall cure rates differed between BID or once-daily (QD) versus more frequent dosing schedules in the treatment of streptococcal tonsillopharyngitis.Data Sources. Candidate studies for this meta-analysis included all clinical trials of therapy for streptococcal tonsillopharyngitis published through August 1998 and identified using Medline, Dissertation Abstracts, conference proceedings, and bibliographies of all retrieved articles.Study Selection. A study was eligible for inclusion if it was a randomized clinical trial that compared the efficacies of different dosing frequencies of 10-day penicillin or amoxicillin in the treatment of streptococcal tonsillopharyngitis. Of the 30 articles initially identified, 6 studies met eligibility criteria.Outcome Measure. The measure of interest was the difference in proportion cured between the BID or QD dosing group and the comparison group with more frequent dosing.Results. The results of this analysis suggest that BID dosing of 10-day penicillin is as efficacious as more frequent dosing regimens in the treatment of streptococcal tonsillopharyngitis. This result also holds true in a subgroup analysis confined to pediatric cases and does not vary with total daily dose of the regimen. QD dosing of penicillin is associated with a cure rate that is 12 percentage points lower than more frequent dosing (95% confidence interval: 3-21). In contrast, this decreased efficacy is not found with QD dosing of amoxicillin.Conclusions. This meta-analysis supports current recommendations for BID dosing of penicillin in treating streptococcal tonsillopharyngitis. QD penicillin is associated with decreased efficacy and should not be used. Simplified regimens of amoxicillin of shorter duration or of less frequent dosing should be further investigated. Pediatrics 2000;105(2). URL: http://www.pediatrics.org/ cgi/content/full/105/2/e19; amoxicillin, group A streptococcal, penicillin, pharyngitis, streptococcal infections, Streptococcus pyogenes.ABBREVIATIONS. GABHS, group A ␤-hemolytic streptococcus; BID, twice-daily; QD, once-daily; TID, 3-times-daily; QID, 4-timesdaily; CI, confidence interval. G roup A ␤-hemolytic streptococcus (GABHS) is the most common bacterial cause of acute tonsillopharyngitis in the pediatric population.1 An estimated 11% of all school-aged children in the United States visit a doctor every year for tonsillopharyngitis.2 Diagnosis and prompt treatment of streptococcal tonsillopharyngitis is essential to prevent acute rheumatic fever, which can lead to permanent heart valve damage and the subsequent need for lifelong antibiotics, and to prevent suppurative complications, such as peritonsillar ab...

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Treatment of streptococcal pharyngotonsillitis: Reports of penicillin's demise are premature

Cited by 93 publications

References 58 publications

Pathogenesis of Group A Streptococcal Infections

Pathogenesis of Group A Streptococcal Infections

Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis

The Impact of Dosing Frequency on the Efficacy of 10-Day Penicillin or Amoxicillin Therapy for Streptococcal Tonsillopharyngitis: A Meta-analysis

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