Efficacy of β-lactamase-resistant penicillin and influence of penicillin tolerance in eradicating streptococci from the pharynx after failure of penicillin therapy for group A streptococcal pharyngitis

Thomas D. Smith, W Charles Huskins, Kwang Sik Klm, Edward L. Kalan

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Abstract

We studied the ability of dicloxacillin, a β-lactamase-resistant penicillin, to eradicate persistent group A streptococcl from the upper respiratory tract of children previously given penicillin V, and concomitantly assessed the role of antibiotic (penicillin and dicloxacillin) tolerance as a contributing factor. During a group A streptococcal pharyngitis outbreak, 66% of 324 children were found to be culture positive for group A streptococcl. Ninety percent of these isolates were serotype M-1, T-agglutination pattern T-1. The treatment failure rate after initial orally administered penicllin treatment was 21% (42 of 204). These 42 children then received either a second course of penicillin V orally or a course of dicioxacillin. The resulting rates of failure to eradicate the homologous streptococcal serotype were 83% (20 of 24) and 50% (9 of 18). respectively (P<0.02). Of 189 streptococcal isolates tested by the gradient replicate plate method for penicillin tolerance, 18 (10%) were tolerant. In this study, penicillin-tolerant strains of group A streptococci were no more frequently isolated from childen in whom initial penicillin treatment falled than from those who were successfully treted. Dicloxacillin tolerance was not a factor in failure of dicloxicillin therapy. These data, when evaluated with data from previous studies, suggest that reasons for failure to eradicate group A streptococci from the upper respiratory fract are complex, but dicloxacillin may be beneticial in some patients who fail to respond to orally administered penicillin therapy.

Original languageEnglish (US)
Pages (from-to)777-782
Number of pages6
JournalThe Journal of Pediatrics
Volume110
Issue number5
DOIs
StatePublished - 1987
Externally publishedYes

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Pharyngitis
Group Psychotherapy
Dicloxacillin
Pharynx
Streptococcus
Penicillins
Penicillin V
Aptitude
Agglutination
Therapeutics
Treatment Failure
Respiratory System
Disease Outbreaks

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

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title = "Efficacy of β-lactamase-resistant penicillin and influence of penicillin tolerance in eradicating streptococci from the pharynx after failure of penicillin therapy for group A streptococcal pharyngitis",
abstract = "We studied the ability of dicloxacillin, a β-lactamase-resistant penicillin, to eradicate persistent group A streptococcl from the upper respiratory tract of children previously given penicillin V, and concomitantly assessed the role of antibiotic (penicillin and dicloxacillin) tolerance as a contributing factor. During a group A streptococcal pharyngitis outbreak, 66{\%} of 324 children were found to be culture positive for group A streptococcl. Ninety percent of these isolates were serotype M-1, T-agglutination pattern T-1. The treatment failure rate after initial orally administered penicllin treatment was 21{\%} (42 of 204). These 42 children then received either a second course of penicillin V orally or a course of dicioxacillin. The resulting rates of failure to eradicate the homologous streptococcal serotype were 83{\%} (20 of 24) and 50{\%} (9 of 18). respectively (P<0.02). Of 189 streptococcal isolates tested by the gradient replicate plate method for penicillin tolerance, 18 (10{\%}) were tolerant. In this study, penicillin-tolerant strains of group A streptococci were no more frequently isolated from childen in whom initial penicillin treatment falled than from those who were successfully treted. Dicloxacillin tolerance was not a factor in failure of dicloxicillin therapy. These data, when evaluated with data from previous studies, suggest that reasons for failure to eradicate group A streptococci from the upper respiratory fract are complex, but dicloxacillin may be beneticial in some patients who fail to respond to orally administered penicillin therapy.",
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AU - Huskins, W Charles

AU - Klm, Kwang Sik

AU - Kalan, Edward L.

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N2 - We studied the ability of dicloxacillin, a β-lactamase-resistant penicillin, to eradicate persistent group A streptococcl from the upper respiratory tract of children previously given penicillin V, and concomitantly assessed the role of antibiotic (penicillin and dicloxacillin) tolerance as a contributing factor. During a group A streptococcal pharyngitis outbreak, 66% of 324 children were found to be culture positive for group A streptococcl. Ninety percent of these isolates were serotype M-1, T-agglutination pattern T-1. The treatment failure rate after initial orally administered penicllin treatment was 21% (42 of 204). These 42 children then received either a second course of penicillin V orally or a course of dicioxacillin. The resulting rates of failure to eradicate the homologous streptococcal serotype were 83% (20 of 24) and 50% (9 of 18). respectively (P<0.02). Of 189 streptococcal isolates tested by the gradient replicate plate method for penicillin tolerance, 18 (10%) were tolerant. In this study, penicillin-tolerant strains of group A streptococci were no more frequently isolated from childen in whom initial penicillin treatment falled than from those who were successfully treted. Dicloxacillin tolerance was not a factor in failure of dicloxicillin therapy. These data, when evaluated with data from previous studies, suggest that reasons for failure to eradicate group A streptococci from the upper respiratory fract are complex, but dicloxacillin may be beneticial in some patients who fail to respond to orally administered penicillin therapy.

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