TY - JOUR
T1 - 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
AU - Smith, Thomas D.
AU - Huskins, W. Charles
AU - Klm, Kwang Sik
AU - Kalan, Edward L.
N1 - Funding Information:
Supported by grants from the Thrasher Foundation, the U.S. Public Health Service (AI07054), the American Heart Association, the Minnesota Grand Chapter of the Order of the Eastern Star, and the Minnesota Medical Foundation. Dr. Huskins was the recipient of a Medical Student Research Fellowship from the American Heart Association. Submitted for publication Aug. 29, 1986; accepted Dec. 8, 1986. Reprint requests: Edward L. Kaplan, M.D., Department of Pediatrics, Box 296 UMHC, University of Minnesota Medical School, Minneapolis, MN 55455.
PY - 1987/5
Y1 - 1987/5
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.
AB - 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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U2 - 10.1016/S0022-3476(87)80023-9
DO - 10.1016/S0022-3476(87)80023-9
M3 - Article
C2 - 3106607
AN - SCOPUS:0023195464
SN - 0022-3476
VL - 110
SP - 777
EP - 782
JO - The Journal of Pediatrics
JF - The Journal of Pediatrics
IS - 5
ER -