Martin F. Randolph

Once-Daily Therapy for Streptococcal Pharyngitis With Amoxicillin

Objective. An orally administered antimicrobial regimen for the treatment of group A β-hemolytic streptococcal (GABHS) pharyngitis given once rather than multiple times each day would be more convenient and might result in improved patient compliance. The purpose of this study was to evaluate the effectiveness of once-daily amoxicillin in the treatment of GABHS pharyngitis. Patients. Children presenting to a private pediatric office with GABHS pharyngitis. Design. Patients were randomly assigned to receive orally either amoxicillin (750 mg once daily) or penicillin V (250 mg three times a day) for 10 days. Compliance was monitored by urine antimicrobial activity. Outcomes. Outcomes were measured by impact on the clinical course, eradication of GABHS within 18 to 24 hours, and bacteriologic treatment failure rate as determined by follow-up throat cultures 4 to 6 and 14 to 21 days after completing therapy. GABHS isolates were serotyped to distinguish bacteriologic treatment failures (same serotype as initial throat culture) from new acquisitions (different serotypes). Results. During the 16 months of this study, 152 children between 4 and 18 years of age (mean, 9.9 years) were enrolled; 79 children were randomly assigned to receive once-daily amoxicillin and 73 were assigned to receive penicillin V three times a day. The children in the two treatment groups were comparable with respect to age, duration of illness before initiation of therapy, compliance, and signs and symptoms at presentation. There was no significant difference in the clinical or bacteriologic responses of the patients in the two treatment groups at the 18- to 24-hour follow-up visit. Bacteriologic treatment failures occurred in 4 (5%) of the 79 patients in the amoxicillin group and in 8 (11%) of the 73 patients in the penicillin V group. Conclusions. These data demonstrate that once-daily amoxicillin therapy is as effective as penicillin V therapy given three times a day for the treatment of GABHS pharyngitis, and if confirmed by additional investigations, once-daily amoxicillin therapy could become an alternative regimen for the treatment of this disease.

The incidence of asymptomatic bacteriuria and pyuria in infancy: A study of 400 infants in private practice***

Two hundred male and two hundred female infants were surveyed for asymptomatic bacteriuria and pyuria while presenting for routine care in a private pediatric practice. The clean voided specimen was made accessible with the Pediatric Urine Collector at a remarkably low rate of contamination. On the initial screening 2 per cent of the female and no male infants showed bacteriuria. With repeated study of the same infant population the incidence of bacteriuria rose to 4.5 per cent of the female and 0.5 per cent of the male infants. The most reliable single screening procedure was the quantitative colony count, but the value of repeated screening by history, routine urinalysis, as well as by quantitative colony count to exclude urinary infection in the infant was emphasized.

Streptozyme® test for antibodies to Group A streptococcal antigens

The ability of the Streptozyme® test to identify significant antibody rises in 46 patients with streptococcal pharyngitis was comparable to, but no greater than, that of the antistreptolysin O or antideoxyribonuclease B test and inferior to that of the combined use of both the antistreptolysin O and antideoxyribonuclease B tests. Serum specimens were also simultaneously analyzed with three different lots of Streptozyme® reagent. Lot-to-lot variation in the reagent resulted in a significant difference in antibody titer for 18 (19%) of the 92 sera tested. Differences among the three lots also produced variation in determining whether a significant rise in titer had occurred from the acute phase to the convalescent phase serum for a given patient. These observations raise concerns about the standardization of the Streptozyme® reagent and document the need for precise identification and quantitation of the streptococcal antigens used in this product.

Clindamycin-associated colitis in children. A prospective study and a negative report.

a growing recognition of pselidomembranotis colitis (PMC) in association with ctindamycin use. 1-3 The frequency of these reports and the concern generated regarding the possibility of this complication with children prompted this prospective study in a private pediatric practice. Clindamycin has been under investigation in our practice since its introduction in 1969.~ Our favorable experience, in particular never having to discontinue the drug for gastrointestinal manifestations with more than 1,600 patients, prompted our use of this ‘

Streptococcal Pharyngitis: Posttreatment Carrier Prevalence and Clinical Relapse in Children Treated with Clindamycin Palmitate or Phenoxymethyl Penicillin

* Danbury, Conn. ** Assistant Director, Laboratory Division, Connecticut State Department of Health. t Principal Microbiologist, Laboratory Division, Connecticut State Department of Health. Correspondence to Martin F. Randolph, M.D., 70 Deer Hill Avenue, Danbury, Conn. 06810. RECURRENCE or persistence of streptYECURRE ersiste tococcal infections in children despite adequate therapy constitutes a problem which plagues all practicing pediatricians.l.2 Treatment failures have been attributed to various

Instant screening for bacteriuria in children: Analysis of a dipstick

treated for seizure disorders is higher than in a nontreated group. Evidence has accumulated that a syndrome of facial cleft and other malformations, particularly minor ones of the extremities, occur in offspring of women with seizure disorders treated with anticonvulsants. Spidel and Meadow7 described the syndrome, and others have emphasized the minor skeletal abnormalities. One of our children may be included in this catagory.

Role of Chlamydia trachomatis and Mycoplasma pneumoniae in acute pharyngitis in children

In a group of children with acute, nonstreptococcal pharyngitis, only one (2%) of the 44 children tested showed serologic or direct-immunofluorescence evidence of a recent Chlamydia trachomatis infection. Only two (5%) of the 43 children tested showed serologic evidence of a recent Mycoplasma pneumoniae infection. Neither C. trachomatis nor M. pneumoniae appears to be an important cause of acute pharyngitis in children.

A comparison of two streptococcal antibody levels in posttreatment carriers of group A Streptococci. The Relationship between elevated titers and clinical relapse as determined by a new serologic procedure.

* Principal Microbiologist, Laboratory Division, Connecticut State Department of Health, Danbury, Cann. 06810. ** Assistant Director, Laboratory Division, Connecticut State Department of Health. † Danbury, Conn. 06810. OBSERVATIONS~ on clinical relapse among posttreatment carriers have been placed on record,’ The report concerned I ) the comparative efficacy of phenoxymethyl penicillin and of clindamycin palmitate HCL in eradicating group A streptococci from the throats of children ill with beta-hemolytic streptococcal pharyngitis; 2) the prevalence of posttreatment carrier state in children treated with clindamycin as compared with penicillin; 3) the frequency of carrier relapse giving rise to clinical recurrence within a 21-day post-

772 NATURAL IMMUNITY TO PYOGENIC BACTERIA

Acquisition of bacteria possessing antigens cross-reactive with groups A, B, C meningococci (Mgc) and H.influenzae Type B (HIB) was examined in 99 infants. Pharyngeal and rectal swabs were obtained at every visit to the pediatrician (MR) during the first year of life and cultured aerobically on TSB agar containing specific antibody to groups A, B, C Mgc and HIB. Bacteria around which antigen-antibody haloes formed were identified by standard methods. Sera were obtained at 12-15 months of age and tested for bactericidal antibody. Forty-four % of 68 infants who were cultured 4 or more times carried bacteria in the rectal culture cross-reactive with group B Mgc and 38% acquired pharyngeal organisms which cross-reacted with group C Mgc. Less than 2% of infants had bacteria cross-reactive with group A Mgc or HIB. Bacteria associated with cross-reactions included: Group A Mgc (Staph. aureus and Staph. epidermidis), Group B Mgc (E.coli, Streptococcus viridans), Group C Mgc (Streptococcus viridans), and HIB (E.coli). Bactericidal antibody against group B Mgc was present at 1 year of age in 84% of carriers of cross-reactive E.coli but was not found against group C Mgc in carriers of cross-reactive Streptococci.

Once Daily Amoxicillin Therapy for the Treatment of Group A Beta-Hemolytic Streptococcal (GABHS) Pharyngitis • 699

Once Daily Amoxicillin Therapy for the Treatment of Group A Beta-Hemolytic Streptococcal (GABHS) Pharyngitis • 699