Comparison of Erythromycin Ethyl Succinate, Stearate and Estolate Treatments of Group A Streptococcal Infections of the Upper Respiratory Tract

1975 ◽  
Vol 14 (12) ◽  
pp. 1098-1110 ◽  
Author(s):  
R. S. Janicki ◽  
J. C. Garnham ◽  
M. C. Worland ◽  
W. E. Grundy ◽  
J. R. Thomas
Keyword(s):  
Respiratory Tract ◽  
Oral Treatment ◽  
Upper Respiratory Tract ◽  
Streptococcal Infections ◽  
Acute Group ◽  
Clinical Responses ◽  
Group A ◽  
Upper Respiratory ◽  
Initiation Of Therapy

The microbiologic and clinical responses of acute Group A beta-hemolytic streptococcal infections of the upper respiratory tract to oral treatment with erythromycin ethyl succinate, stearate, and estolate were studied in 303 patients. Streptococcal M and T typing was done on all positive cultures. The overall cure rate was 95.4 per cent, with no statistically significant differences in clearing organisms from the pharynx. Of the 285 cured patients who completed the prescribed follow-up period, 11 had recurrences between the 12th and 31st day after initiation of therapy, and five developed new infections. No cases of rheumatic fever or glomerulonephritis were encountered during a follow-up study. Eight gastrointestinal reactions and one transient rash occurred. Results with these forms of erythromycin compare favorably with published results for similar infections treated with oral penicillins.

INFLUENCE OF PENICILLINASE-PRODUCING STAPHYLOCOCCI ON THE ERADICATION OF GROUP A STREPTOCOCCI FROM THE UPPER RESPIRATORY TRACT BY PENICILLIN TREATMENT

PEDIATRICS ◽  
1966 ◽  
Vol 37 (3) ◽  
pp. 467-476 ◽  
Author(s):  
Paul G. Quie ◽  
Howard C. Pierce ◽  
Lewis W. Wannamaker
Keyword(s):  
Respiratory Tract ◽  
Respiratory Illness ◽  
Penicillin G ◽  
Group A Streptococci ◽  
Upper Respiratory Tract ◽  
Benzathine Penicillin G ◽  
Group A ◽  
Upper Respiratory ◽  
Penicillin Treatment

Penicillinase-producing strains of S. aureus were isolated from the upper respiratory tract of 28% of a group of children presenting with signs or symptoms of respiratory illness and group A streptococci on cultures from the pharynx or anterior nares. Although group A streptococci were found in 10% of the children 14 to 30 days after penicillin treatment, no correlation was found between the presence of penicillinase-producing S. aureus initially or at follow-up and re-isolation of group A streptococci. There was no suggestion from these studies that antibiotic therapy aimed at penicillin-resistant staphylococci would be of any greater value than intramuscular benzathine penicillin G for the treatment of patients with group A streptococci in the upper respiratory tract.

Effects of procalcitonin testing on antibiotic use and clinical outcomes in patients with upper respiratory tract infections. An individual patient data meta-analysis

2017 ◽  
Vol 56 (1) ◽  
Author(s):  
Jonas Odermatt ◽  
Natalie Friedli ◽  
Alexander Kutz ◽  
Matthias Briel ◽  
Heiner C. Bucher ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Therapy ◽  
Respiratory Tract Infections ◽  
Meta Analysis ◽  
Antibiotic Exposure ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Restricted Activity ◽  
Tract Infections

AbstractBackground:Several trials found procalcitonin (PCT) helpful for guiding antibiotic treatment in patients with lower respiratory tract infections and sepsis. We aimed to perform an individual patient data meta-analysis on the effects of PCT guided antibiotic therapy in upper respiratory tract infections (URTI).Methods:A comprehensive search of the literature was conducted using PubMed (MEDLINE) and Cochrane Library to identify relevant studies published until September 2016. We reanalysed individual data of adult URTI patients with a clinical diagnosis of URTI. Data of two trials were used based on PRISMA-IPD guidelines. Safety outcomes were (1) treatment failure defined as death, hospitalization, ARI-specific complications, recurrent or worsening infection at 28 days follow-up; and (2) restricted activity within a 14-day follow-up. Secondary endpoints were initiation of antibiotic therapy, and total days of antibiotic exposure.Results:In total, 644 patients with a follow up of 28 days had a final diagnosis of URTI and were thus included in this analysis. There was no difference in treatment failure (33.1% vs. 34.0%, OR 1.0, 95% CI 0.7–1.4; p=0.896) and days with restricted activity between groups (8.0 vs. 8.0 days, regression coefficient 0.2 (95% CI –0.4 to 0.9), p=0.465). However, PCT guided antibiotic therapy resulted in lower antibiotic prescription (17.8% vs. 51.0%, OR 0.2, 95% CI 0.1–0.3; p<0.001) and in a 2.4 day (95% CI –2.9 to –1.9; p<0.001) shorter antibiotic exposure compared to control patients.Conclusions:PCT guided antibiotic therapy in the primary care setting was associated with reduced antibiotic exposure in URTI patients without compromising outcomes.

Significance of Quantitative Salivary Cultures for Group A and Non-group A β-Hemolytic Streptococci in Patients with Pharyngitis and in Their Family Contacts

PEDIATRICS ◽  
1979 ◽  
Vol 64 (6) ◽  
pp. 904-912
Author(s):  
Edward L. Kaplan ◽  
Robert Couser ◽  
Barbara Ballard Huwe ◽  
Carolyn Mckay ◽  
Lewis W. Wannamaker
Keyword(s):  
Antibody Response ◽  
Respiratory Tract ◽  
Group A Streptococci ◽  
Upper Respiratory Tract ◽  
C Reactive Protein ◽  
Throat Culture ◽  
Reactive Protein ◽  
Group A ◽  
Bona Fide ◽  
Upper Respiratory

One hundred ninety-six individuals, 86 with clinically overt pharyngotonsillitis and 110 of their clinically negative contacts were studied to evaluate the sensitivity and the specificity of quantitative saliva cultures for group A β-hemolytic streptococci. We also compared this technique with semiquantitative throat cultures as a means of isolating group A streptococci and of differentiating the streptococcal carrier state from patients with bona fide streptococcal upper respiratory tract infection as defmed by the presence of an antibody response. The data indicate that the throat culture is a more reliable means of identifying group A β-hemolytic streptococci in the upper respiratory tract than is the saliva culture. The converse is true for non-group A β-hemolytic streptococci; the saliva culture is a much better means for isolating these organisms. In individuals positive by both techniques we found good correlation between the degree of positivity of the saliva culture and the degree of positivity of the throat culture. Furthermore, while there was a definite trend for individuals with strongly positive cultures to demonstrate more often an antibody rise in either antistreptolysin O and/or antideoxynibonuclease B—indicating bona fide infection—this relationship was not sufficiently constant to provide a clear differentiation. This study also indicates that discordance (one positive, one negative) of simultaneous duplicate semiquantitative throat cultures is much more common among individuals who do not show an antibody response ("carriers") than among those with an antibody response (bona fide infection). This study confirms our previous observations suggesting that the presence of C-reactive protein in the serum of patients with a positive culture for group A streptococci and clinical signs and symptoms of pharyngitis is often an indication of true streptococcal upper respiratory tract infection, and that even with a positive saliva culture at the initial visit, a negative C-reactive protein is only infrequently (25%) associated with an antibody response.

scholarly journals BACTERIOSTATIC EFFECT OF HUMAN SERA ON GROUP A STREPTOCOCCI

1945 ◽  
Vol 82 (2) ◽  
pp. 93-106 ◽  
Author(s):  
Sidney Rothbard
Keyword(s):  
Streptococcal Infection ◽  
Upper Respiratory Tract ◽  
Streptococcal Infections ◽  
Bacteriostatic Effect ◽  
The Third ◽  
Human Sera ◽  
Group A ◽  
Human Adults ◽  
Upper Respiratory ◽  
Different Strains

1. Type-specific antibodies were demonstrated by the indirect bacteriostatic test in sera from human adults convalescing from group A streptococcal infection of the upper respiratory tract. The time of appearance of the antibodies varied from 3 to 5 weeks; and they persisted in 2 patients for at least 37 weeks after the onset of the infection. 2. The specificity of the antibody response in one serum was tested with strains of 7 heterologous types; in another, with 6; and in the third, with 2; but in no instance were cross-reactions observed. Moreover, each convalescent serum showed approximately equal bacteriostasis for 7 different strains of the same type as that which caused the infection. 3. The antibodies were specifically absorbed from the serum by homologous heat-killed streptococci, but not significantly by strains of heterologous types. 4. The specific M antigen of the streptococcal cell with its respective antibody, and not the T substance, appeared to be concerned in the reaction. 5. In spite of numerous technical difficulties inherent in the method, this bacteriostatic test provides a useful procedure for studying type-specific immunity in streptococcal infections.

scholarly journals Group A Streptococcus Infection of the Nasopharynx Requires Proinflammatory Signaling Through the Interleukin-1 Receptor

2020 ◽  
Author(s):  
Doris L. LaRock ◽  
Raedeen Russell ◽  
Anders F. Johnson ◽  
Shyra Wilde ◽  
Christopher N. LaRock
Keyword(s):  
Respiratory Tract ◽  
Proinflammatory Cytokine ◽  
Interleukin 1 ◽  
Neutrophil Migration ◽  
High Morbidity ◽  
Invasive Infection ◽  
Upper Respiratory Tract ◽  
Group A ◽  
Upper Respiratory ◽  
Strep Throat

ABSTRACTGroup A Streptococcus (GAS) is the etiologic agent of numerous high morbidity and high mortality diseases which commonly have a highly proinflammatory pathology. One factor contributing to this inflammation is the GAS protease SpeB, which directly activates the proinflammatory cytokine interleukin-1β (IL-1β), independent of the canonical inflammasome pathway. IL-1β drives neutrophil activation and recruitment that limits bacterial growth and invasion during invasive skin and soft tissue infections like necrotizing fasciitis. GAS also causes pharyngitis (strep throat), and the upper respiratory tract is its primary nidus for growth and transmission. Since the fitness selection for the species is likely primarily for this site, we examined the process of IL-1β activation in the murine nasopharynx. SpeB still activated IL-1β, which was required for neutrophil migration, but this inflammation instead increased GAS replication. Inhibiting IL-1β or depleting neutrophils, which both promote invasive infection, prevented GAS infection of the nasopharynx. Prior antibiotic exposure increased GAS growth in the murine nasopharynx, and antibiotics were sufficient to reverse the attenuation previously observed when IL-1β, neutrophils, or SpeB were not present to drive inflammation. Therefore, the same fundamental mechanism has opposing effects on virulence at different body sites. Invasive disease may be limited in part due to specific adaptations for inducing host inflammation that are beneficial for pharyngitis.IMPORTANCEOur previous reports showed that Group A Streptococcus (GAS) protease SpeB directly activates the host proinflammatory cytokine IL-1β and this restricts invasive skin infection. The upper respiratory tract is the primary site of GAS colonization and infection, but the host-pathogen interactions at this site are still largely unknown. We provide the first evidence that IL-1β-mediated inflammation promotes upper respiratory tract infection. This provides experimental evidence that the notable inflammation of strep throat, which presents with significant swelling, pain, and neutrophil influx, is not an ineffectual immune response, but rather is a GAS-directed remodeling of this niche for its pathogenic benefit.

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