EPIDEMIOLOGY OF A STREPTOCOCCAL OUTBREAK IN A SCHOOL: ATTEMPT AT CONTROL BY MASS PROPHYLAXIS WITH PENICILLIN V

PEDIATRICS ◽  
1958 ◽  
Vol 21 (4) ◽  
pp. 624-634
Author(s):  
David C. Poskanzer ◽  
Harry A. Feldman ◽  
Thomas W. Mou ◽  
Kenzo Kuroda
Keyword(s):  
Age Distribution ◽  
Group A Streptococci ◽  
Once Daily ◽  
Penicillin V ◽  
Focus Of Infection ◽  
Group A ◽  
Resistance To Penicillin ◽  
The Individual ◽  
Families With Children ◽  
Made In

An attempt was made to abort an epidemic of streptococcal infection in a rural school including kindergarten through third grade by the use of mass, oral penicillin V prophylaxis for 10 days. Half of the classes received 200,000 units of penicillin V once daily and the others received two doses daily. In both instances, there was a decline in the carrier rates but neither regimen was entirely satisfactory. Unusual resistance to penicillin could not be demonstrated in streptococci isolated after the treatment period. Carrier studies were conducted in 124 families of children in the school sample. Prior to the prophylaxis regimen the carrier rate for Group A streptococci was 7% for adults more than 24 years of age and 24% in their children in the school being studied. Forty families which did not have children in the school also were cultured. None of the adults more than 24 years of age in this group was found to have streptococci in contrast with 4% of adults (cultured the same day) in the school-associated families. These observations tend to support the hypothesis that the school is the focus of infection and that families with children in school have a higher rate of infection than families without children in school. However, in both groups of families the adults appeared to be relatively resistant to infection. Within the school, the focus of infection appeared to be the individual classroom rather than the grade level. Rates of positive cultures for Group A streptococci in different classrooms within the same grade ranged from 0 to 71%. Numerous isolations of Group C streptococci were made in the school population. The age distribution paralleled the age distribution of the children from whom Group A organisms were isolated. In addition, titers of antistreptolysin-O in persons from whom Group C organisms were isolated were similar to those in persons with Group A strains. It is suggested that Group C infections may have contributed to the course of the epidemic.

scholarly journals Streptococcal pharyngitis in general practice. 1. Some unusual features of the epidemiology

1992 ◽  
Vol 109 (2) ◽  
pp. 181-189 ◽  
Author(s):  
P. M. Higgins
Keyword(s):  
Sore Throat ◽  
Age Distribution ◽  
Positive Culture ◽  
Streptococcal Pharyngitis ◽  
Group A Streptococci ◽  
Upper Respiratory Tract ◽  
Acute Infections ◽  
Group A ◽  
Upper Respiratory ◽  
Highly Correlated

SUMMARYThis report is based on a study of acute infections of the upper respiratory tract in 1965 and detailed records of such infections in 1963 and 1964. A change from illnesses mainly yielding viruses to illnesses mainly yielding group A streptococci was noted around the age of 5 years. A positive culture for group A streptococci in patients over 4 years of age was highly correlated with a complaint of sore throat and with serological evidence of streptococcal infection. A bimodal age distribution curve for pharyngitis associated with a positive culture for group A streptococci was consistently noted. The incidence was highest in children aged 5–9 but a second smaller peak occurred among adults in the 30–39 age group. The evidence suggests that being female increases the risk of acquiring group A streptococci and of experiencing sore throat.

ERYTHROMYCIN PROPIONATE AND POTASSIUM PENICILLIN V IN THE TREATMENT OF GROUP A STREPTOCOCCAL PHARYNGITIS

PEDIATRICS ◽  
1963 ◽  
Vol 31 (1) ◽  
pp. 22-28
Author(s):  
Maxwell Stillerman ◽  
Stanley H. Bernstein ◽  
Martha Smith ◽  
Jack D. Gorvoy
Keyword(s):  
Relative Effectiveness ◽  
Streptococcal Pharyngitis ◽  
Group A Streptococci ◽  
Cure Rate ◽  
Acute Pharyngitis ◽  
Penicillin V ◽  
Daily Dose ◽  
Group A ◽  
Potassium Penicillin

The relative effectiveness of erythromycin propionate and K penicillin V in two dosage schedules was evaluated in the treatment of 261 cases of acute pharyngitis from which Group A hemolytic streptococci were recovered from December, 1958, to June, 1959. Erythromycin propionate, in a daily dose of 30 mg/kg up to 1.0 gm, and K penicillin V, in daily doses of 375 mg and 750 mg, were administered orally for 10 days. The adjusted bacterial cure rate was 78% among 86 patients treated with erythromycin, 72% among 102 patients treated with K penicillin V, 375 mg, and 88% among 73 patients treated with K penicillin V, 750 mg. The data indicate that K penicillin V was more effective in eradicating Group A streptococci from the pharynx in a daily dose of 750 mg than 375 mg, and suggest that erythromycin propionate in the dosage used, was less effective than K penicillin V, 750 mg, but equally as effective as K penicillin V, 375 mg daily. The incidence, time of occurrence, and results of retreatments of bacterial relapses are presented, and two possible causes of relapses are considered.

scholarly journals Comparative efficacy and safety of 3-day azithromycin and 10-day penicillin V treatment of group A beta-hemolytic streptococcal pharyngitis in children.

1996 ◽  
Vol 40 (4) ◽  
pp. 1005-1008 ◽  
Author(s):  
L Pacifico ◽  
F Scopetti ◽  
A Ranucci ◽  
M Pataracchia ◽  
F Savignoni ◽  
...  
Keyword(s):  
Clinical Success ◽  
Streptococcal Pharyngitis ◽  
Efficacy And Safety ◽  
Comparative Efficacy ◽  
Once Daily ◽  
Penicillin V ◽  
Oral Regimen ◽  
Beta Hemolytic Streptococcus ◽  
Group A

The efficacy and safety of a 3-day course of azithromycin oral suspension (10 mg/kg of body weight once daily) were compared with those of penicillin V (50,000 U/kg/day in two divided doses) in children aged 3 to 12 years for the treatment of symptomatic pharyngitis caused by the group A beta-hemolytic streptococcus (GABHS). For the 154 evaluable patients, the original infecting strain of GABHS was eliminated at the end of follow-up (34 to 36 days after treatment started) from 67 (85.8%) of 78 penicillin-treated patients and 41 (53.9%) of 76 azithromycin-treated patients (P < 0.0001). Overall clinical success was achieved in 71 (91.0%) of 78 penicillin V-treated patients and 57 (75.0%) of 76 azithromycin-treated patients (P < 0.05). Potential drug-related adverse events were reported for 5.5 and 8.6% of the penicillin V- and azithromycin-treated patients, respectively (P = 0.6). In the present study, a once-daily (10 mg/kg), 3-day oral regimen of azithromycin was as safe as a 10-day course of penicillin but did not represent an effective alternative to penicillin for the treatment of GABHS pharyngitis, even for those children with azithromycin-susceptible strains.

Persistence of group A streptococci as related to penicillinase-producing staphylococci: Comparison of penicillin V potassium and sodium nafcillin

1967 ◽  
Vol 71 (1) ◽  
pp. 132-137 ◽  
Author(s):  
Milton Markowitz ◽  
Irving Kramer ◽  
Eugene Goldstein ◽  
Anthony Perlman ◽  
Donald Klein ◽  
...  
Keyword(s):  
Group A Streptococci ◽  
Penicillin V ◽  
Group A ◽  
Sodium Nafcillin

Once-daily amoxicillin versus twice-daily penicillin V in group A  -haemolytic streptococcal pharyngitis

2008 ◽  
Vol 93 (6) ◽  
pp. 474-478 ◽  
Author(s):  
D R Lennon ◽  
E Farrell ◽  
D R Martin ◽  
J M Stewart
Keyword(s):  
Streptococcal Pharyngitis ◽  
Once Daily ◽  
Penicillin V ◽  
Group A

scholarly journals Serological characterization of group-A streptococci associated with skin sepsis in meat handlers

1977 ◽  
Vol 78 (2) ◽  
pp. 283-296 ◽  
Author(s):  
Cherry A. M. Fraser ◽  
Lyn C. Ball ◽  
C. A. Morris ◽  
N. D. Noah
Keyword(s):  
Group A Streptococcus ◽  
Group A Streptococci ◽  
Intensive Study ◽  
The Third ◽  
Serological Characterization ◽  
Group A ◽  
Sporadic Infection ◽  
Made In

SUMMARYA series of outbreaks of skin sepsis among meat handlers in England during 1974 and 1975 afforded an opportunity to study the group-A streptococci commonly isolated from the lesions. Few of these streptococci could be M typed with existing antisera. Intensive study of strains from two outbreaks of sepsis in one abattoir in Shropshire led to the recognition of three new provisional M types. The streptococci were first sorted according to T-typing pattern and ability to produce opacity factor. Opacity-factor producing strains with the same T pattern were then screened for inhibition of opacity production by the sera of convalescents from the same outbreak. Finally, M antisera were made in rabbits against representative cultures.Sera against the three new provisional types were used to re-examine streptococci from 20 other outbreaks or incidents of sporadic infection among meat handlers. This increased the proportion of typable strains from 3% to 55%. Two of the new provisional types (nos. 2015 and 1658; both T25/Imp 19, opacity-factor positive) were confined to the Shropshire outbreak, but the third (no. 2681; T14, opacity-factor negative) was found among strains from meat workers in eight other geographically distinct areas. In all, 31% of 131 distinct strains from meat workers, but less than 1% of 2816 strains from other British sources, belonged to provisional type 2681. Thus, in Britain, one M-type of group-A streptococcus appears at present to be almost exclusively associated with sepsis in meat workers.

scholarly journals Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study

BMJ ◽  
2019 ◽  
pp. l5337 ◽  
Author(s):  
Gunilla Skoog Ståhlgren ◽  
Mia Tyrstrup ◽  
Charlotta Edlund ◽  
Christian G Giske ◽  
Sigvard Mölstad ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Cure ◽  
Day Treatment ◽  
Group A Streptococci ◽  
Open Label ◽  
Link Type ◽  
Penicillin V ◽  
Bacteriological Eradication ◽  
Group A ◽  
Randomised Controlled

Abstract Objective To determine whether total exposure to penicillin V can be reduced while maintaining adequate clinical efficacy when treating pharyngotonsillitis caused by group A streptococci. Design Open label, randomised controlled non-inferiority study. Setting 17 primary healthcare centres in Sweden between September 2015 and February 2018. Participants Patients aged 6 years and over with pharyngotonsillitis caused by group A streptococci and three or four Centor criteria (fever ≥38.5°C, tender lymph nodes, coatings of the tonsils, and absence of cough). Interventions Penicillin V 800 mg four times daily for five days (total 16 g) compared with the current recommended dose of 1000 mg three times daily for 10 days (total 30 g). Main outcome measures Primary outcome was clinical cure five to seven days after the end of antibiotic treatment. The non-inferiority margin was prespecified to 10 percentage points. Secondary outcomes were bacteriological eradication, time to relief of symptoms, frequency of relapses, complications and new tonsillitis, and patterns of adverse events. Results Patients (n=433) were randomly allocated to the five day (n=215) or 10 day (n=218) regimen. Clinical cure in the per protocol population was 89.6% (n=181/202) in the five day group and 93.3% (n=182/195) in the 10 day group (95% confidence interval −9.7 to 2.2). Bacteriological eradication was 80.4% (n=156/194) in the five day group and 90.7% (n=165/182) in the 10 day group. Eight and seven patients had relapses, no patients and four patients had complications, and six and 13 patients had new tonsillitis in the five day and 10 day groups, respectively. Time to relief of symptoms was shorter in the five day group. Adverse events were mainly diarrhoea, nausea, and vulvovaginal disorders; the 10 day group had higher incidence and longer duration of adverse events. Conclusions Penicillin V four times daily for five days was non-inferior in clinical outcome to penicillin V three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci. The number of relapses and complications did not differ between the two intervention groups. Five day treatment with penicillin V four times daily might be an alternative to the currently recommended 10 day regimen. Trial registration EudraCT 2015-001752-30; ClinicalTrials.gov NCT02712307 .

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