TY - JOUR
T1 - Clindamycin treatment of chronic pharyngeal carriage of group A streptococci
AU - Tanz, Robert R.
AU - Poncher, John R.
AU - Corydon, Kathleen E.
AU - Kabat, Kathleen
AU - Yogev, Ram
AU - Shulman, Stanford T.
N1 - Funding Information:
Despite universal susceptibility of group A r streptococci strains to penicillin, they may persist after treatment. Children whose throat cultures are persistently positive for GABHS pose several difficult problems. Some Supported by a grant from The Upjohn Company. Presented in part at the Tenth Lancefield International Symposium on Streptococci and Streptococcal Diseases, Cologne, Federal Republic of Germany, September 1987, and at the annual meeting of the American Pediatric Society, Washington, D.C., May 1988. Submitted for publication Dec. 14, 1990; accepted Feb. 8, 1991. Reprint requests: Robert R. Tanz, MD, Division of General Academic and Emergency Pediatrics, Box 16, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614. 9/25/28587 may be experiencing repeated discrete episodes of acute streptococcal pharyngitis, and antibiotic therapy is indicated. Others are chronically colonized and have positive throat cultures whether or not symptoms are present; these
PY - 1991/7
Y1 - 1991/7
N2 - We previously demonstrated that chronic pharyngeal carriage of group A β-hemolytic streptococci (GABHS) can be terminated by intramuscular administration of bezathine penicillin plus 4 days of orally administered rifampin. Because an effective oral regimen would be desirable, we compared clindamycin with P+R for treating GABHS carriage. Healthy, symptom-free GABHS carriers were randomly assigned to receive orally administered clindamycin (20 mg/kg per day) three times a day for 10 days or intramuscularly administered benzathine penicillin with oral doses of rifampin (20 mg/kg per day) twice a day for 4 days. Compliance, was documented by antibiotic activity in urine. Throat cultures for GABHS were obtained every 3 weeks for up to 9 weeks after treatment. Patients who had positive throat cultures for their original GABHS T type 3 weeks after randomization were crossed over to the other treatment. Treatment success was defined as eradication of the original GABHS T type, with all follow-up cultures negative. Clindamycin eradicated carriage in 24 (92%) of 26 patients; penicillin plus rifampin was effective in 12 (55%) of 22 patients (p <0.025). Including patients crossed over 3 weeks after enrollment, clindamycin was effective in 28 (85%) of 33 treatment courses compared with 12 of 22 courses of penicillin plus rifampin (p<0.05). We conclude that 10 days of oral clindamycin therapy was significantly more effective than benzathine penicillin plus 4 days of orally administered rifampin for treatment of symptom-free GABHS carriers.
AB - We previously demonstrated that chronic pharyngeal carriage of group A β-hemolytic streptococci (GABHS) can be terminated by intramuscular administration of bezathine penicillin plus 4 days of orally administered rifampin. Because an effective oral regimen would be desirable, we compared clindamycin with P+R for treating GABHS carriage. Healthy, symptom-free GABHS carriers were randomly assigned to receive orally administered clindamycin (20 mg/kg per day) three times a day for 10 days or intramuscularly administered benzathine penicillin with oral doses of rifampin (20 mg/kg per day) twice a day for 4 days. Compliance, was documented by antibiotic activity in urine. Throat cultures for GABHS were obtained every 3 weeks for up to 9 weeks after treatment. Patients who had positive throat cultures for their original GABHS T type 3 weeks after randomization were crossed over to the other treatment. Treatment success was defined as eradication of the original GABHS T type, with all follow-up cultures negative. Clindamycin eradicated carriage in 24 (92%) of 26 patients; penicillin plus rifampin was effective in 12 (55%) of 22 patients (p <0.025). Including patients crossed over 3 weeks after enrollment, clindamycin was effective in 28 (85%) of 33 treatment courses compared with 12 of 22 courses of penicillin plus rifampin (p<0.05). We conclude that 10 days of oral clindamycin therapy was significantly more effective than benzathine penicillin plus 4 days of orally administered rifampin for treatment of symptom-free GABHS carriers.
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U2 - 10.1016/S0022-3476(05)81052-2
DO - 10.1016/S0022-3476(05)81052-2
M3 - Article
C2 - 2066844
AN - SCOPUS:0025764485
VL - 119
SP - 123
EP - 128
JO - Journal of Pediatrics
JF - Journal of Pediatrics
SN - 0022-3476
IS - 1 PART 1
ER -