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The extended microbiology of group a streptococcal pharyngitis. Observations during a double-blind controlled study of cephalexin twice versus four-times daily

Erweiterte Mikrobiologie der Pharyngitis durch Streptokokken der Gruppe A. Beobachtungen anläßlich einer kontrollierten Doppelblindstudie zu Cephalexin zweimal täglich im Vergleich zu viermal täglicher Dosierung

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Summary

In a double-blind controlled study we compared the effectiveness of cephalexin b.i.d. versus q.i.d. in the treatment of group A streptococcal pharyngitis in 65 children. Clinical improvement was noted in 64 patients (98%) and bacteriologic cure in 60 (92%). Despite good compliance, three bacteriologic failures were noted in the q.i.d., and two in the b.i.d. treatment groups. Two of these five were carriers. Significant antibody responses were observed in 61% of the patients by at least one of three tests (ASO, anti-DNase B, Streptozyme). We also investigated the extended microbiology of streptococcal pharyngitis by looking for the presence of viruses, chlamydia and β-lactamase producing organisms in the pharynx. Respiratory viruses were isolated concomitantly withStreptococcus pyogenes in six patients. β-lactamase producing bacteria were present in the pharynx of 98% of the patients at the initiation of treatment and comprised 1–98% of the total bacterial flora. The β-lactamase producing flora did not significantly change with cephalexin therapy.

Zusammenfassung

In einer doppelblind kontrollierten Studie haben wir die Wirkung von Cephalexin bei zweimal täglicher gegenüber viermal täglicher Verabreichung in der Behandlung der Pharyngitis durch Streptokokken der Gruppe A bei 65 Kindern untersucht. Eine klinische Besserung wurde bei 64 Patienten (98%) festgestellt und eine bakteriologische Heilung bei 60 Patienten (92%). Trotz guter Mitarbeit der Patienten wurden drei bakteriologische Versager in der Gruppe, die vier Dosen täglich erhielt, festgestellt und zwei Versager in der zweimal täglich behandelten Gruppe. Zwei von diesen fünf Patienten waren Keimtended träger. Eine signifikante Antikörperantwort wurde bei 61% der Patienten in mindestens einem der drei Tests (ASO, Anti-DNase B, Streptozym) beobachtet. Wir haben außerdem erweiterte mikrobiologische Untersuchungen bei Streptokokken-Pharyngitis durchgeführt und nach Viren, Chlamydien und β-Laktamase produzierenden Erregern im Rachen gesucht. Bei sechs Patienten wurden Viren des Respirationstraktes zusammen mitStreptococcus pyogenes isoliert. β-Laktamase bildende Bakterien waren im Rachen von 98% aller Patienten zu Beginn der Behandlung vorhanden und umfaßten 1–98% der gesamten bakteriellen Flora. Die β-Laktamase produzierende Flora wurde durch Behandlung mit Cephalexin nicht wesentlich verändert.

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Literature

  1. Catanzaro, F. J., Rammelkamp, Jr., C. H., Chamovitz, R. Prevention of rheumatic fever by treatment of streptococcal infections. II. Factors responsible for failures. N. Engl. J. Med. 259 (1958) 51–57.

    Google Scholar 

  2. Stillerman, M., Isenberg, H. D., Moody, M. Streptococcal pharyngitis therapy. Am. J. Dis. Child. 123 (1972) 457–461.

    Google Scholar 

  3. Gastanaduy, A. S., Huwe, B. B., Kaplan, E. L. Failure of penicillin to eradicate group A streptococci during an outbreak of pharyngitis. Lancet II (1980) 498–501.

    Google Scholar 

  4. Istre, G. R., Welch, D. F., Marks, M. I. Susceptibility of group A beta-hemolytic Streptococcus isolates to penicillin and erythromycin. Antimicrob. Agents Chemother. 20 (1981) 244–246.

    Google Scholar 

  5. Maruyama, S., Yoshioka, H., Fujita, K. Sensitivity of group A streptococci to antibiotics. Am. J. Dis. Child. 133 (1979) 1143–1145.

    Google Scholar 

  6. Henness, D. M., Woodhams, W. Efficacy and tolerability of cefadroxil in bacterial pharyngitis: Comparison with potassium penicillin V. Curr. Therap. Res. 27 (1980) 263–271.

    Google Scholar 

  7. Stillerman, M. Cefaclor and potassium phenoxymethyl penicillin in group A streptococcal pharyngitis. In:Siegenthaler, W., Lüthy, R. (eds.): Current Chemotherapy — Proceedings of the 10th International Congress of Chemotherapy. American Society for Microbiology, Washington, D. C. 1978, pp. 127–129.

    Google Scholar 

  8. Facklam, R. R. Streptococci and aerococci. In:Lennette, E. H., Balows, A., Hausler, Jr., W. J., Truant, J. P. (eds.): Manual of clinical microbiology, 3rd edition. American Society for Microbiology, Washington, D. C. 1980, p. 88.

    Google Scholar 

  9. Lennette, D. A., Melnick, J. L., Johrling, P. B. Viruses and rickettsiae. In:Lennette, E. H., Balows, A., Hausler, Jr., W. J., Truant, J. P. (eds.): Manual of clinical microbiology, 3rd edition. American Society for Microbiology, Washington, D. C. 1980, p. 760.

    Google Scholar 

  10. Schachter, J. Chlamydiae (Psittacosis-lymphogranuloma venereum-trachoma group). In:Lennette, E. H., Balows, A., Hausler, Jr., W. J., Truant, J. P. (eds.): Manual of clinical microbiology, 3rd edition. American Society for Microbiology, Washington, D. C. 1980, p. 357.

    Google Scholar 

  11. Baldwin, J. N., Strickland, R. H., Cox, M. F. Some properties of the beta-lactamase genes inStaphylococcus epidermidis. Appl. Microbiol. 18 (1969) 628–630.

    Google Scholar 

  12. Kaplan, E. L., Huwe, B. B. The sensitivity and specificity of an agglutination test for antibodies to streptococcal extracellular antigens: A quantitative analysis and comparison of the Streptozyme test with the anti-streptolysin O and anti-deoxyribonuclease B tests. J. Pediatr. 96 (1980) 367–373.

    Google Scholar 

  13. Barry, A. L., Thornsberry, C. Susceptibility testing: diffusion test procedures. In:Lennette, E. H., Balows, A., Hausler, Jr., W. J., Truant, J. P. (eds.): Manual of clinical microbiology, 3rd edition. American Society for Microbiology, Washington, D. C. 1980, p. 463.

    Google Scholar 

  14. Spitzer, T. Q., Harris, B. A. Penicillin V therapy for streptococcal pharyngitis: comparison of dosage schedules. South. Med. J. 70 (1977) 41–42.

    Google Scholar 

  15. Shapera, R. M., Hable, K. A., Matsen, J. M. Erythromycin therapy twice daily for streptococcal pharyngitis. J. Am. Med. Assoc. 226 (1973) 531–535.

    Google Scholar 

  16. Tarpay, M., Marks, M. I., Hopkins, C. Cefaclor therapy twice daily for acute otitis media. Am. J. Dis. Child. 136 (1982) 33–35.

    Google Scholar 

  17. Gatley, M. S. To be taken as directed. J. Roy. Coll. Gen. Practit. 16 (1968) 39–44.

    Google Scholar 

  18. Glezen, W. P., Clyde, Jr., W. A., Senior, R. J. Group A streptococci, mycoplasmas, and viruses associated with acute pharyngitis. J. Am. Med. Assoc. 202 (1967) 119–124.

    Google Scholar 

  19. San Joaquin, V. H., Rettig, P. J., Marks, M. I.: Lack of role ofChlamydia trachomatis (CT) in upper respiratory infections (URI) of children. Pediatr. Res. 16 (1982) 153A.

  20. Goldmeier, D., Darougar, S. Isolation ofChlamydia trachomatis from throat and rectum of homosexual men. Br. J. Vener. Dis. 53 (1977) 184–185.

    Google Scholar 

  21. Watanakunakorn, C., Levy, D. H. Pharyngitis and urethritis due toChlamydia trachomatis. J. Infect. Dis. 147 (1983) 364.

    Google Scholar 

  22. Brook, I., Leyva, F. The treatment of the carrier state of group A beta-hemolytic streptococci with clindamycin. Chemotherapy 27 (1981) 360–367.

    Google Scholar 

  23. Kundsin, R. B., Miller, J. M. Significance of theStaphylococcus aureus carrier state in the treatment of disease due to group A streptococci. N. Engl. J. Med. 271 (1964) 1395–1397.

    Google Scholar 

  24. Quie, P. G., Pierce, H. C., Wannamaker, L. W. Influence of penicillinase-producing staphylococci on the eradication of group A streptococci from the upper respiratory tract by penicillin treatment. Pediatrics 37 (1966) 467–476.

    Google Scholar 

  25. Kaplan, E. L., Kunde, C. Quantitative evaluation of variation in composition of the Streptozyme agglutination reagent for detection of antibodies to group A streptococcal extracellular antigens. J. Clin. Microbiol. 14 (1981) 678–680.

    Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Division of Infectious Diseases and Oklahoma Children's Memorial Hospital, Outpatient Department, University of Oklahoma Health Sciences Center, Oklahoma City, OK, U.S.A.

    Martha M. Tarpay M.D., S. Chartrand M.D., M. Marks M.D. & A. Cox M.D.

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  1. Martha M. Tarpay M.D.
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  2. S. Chartrand M.D.
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  3. M. Marks M.D.
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  4. A. Cox M.D.
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Tarpay, M.M., Chartrand, S., Marks, M. et al. The extended microbiology of group a streptococcal pharyngitis. Observations during a double-blind controlled study of cephalexin twice versus four-times daily. Infection 12, 181–184 (1984). https://doi.org/10.1007/BF01640895

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