ANTIBIOTICS IN THE TREATMENT OF BETA-HEMOLYTIC STREPTOCOCCAL PHARYNGITIS: FACTORS INFLUENCING THE RESULTS

PEDIATRICS ◽  
1960 ◽  
Vol 25 (1) ◽  
pp. 27-34
Author(s):  
Maxwell Stillerman ◽  
S. H. Bernstein ◽  
Martha L. Smith ◽  
Stanley B. Gittelson ◽  
Samuel Karelitz
Keyword(s):  
Clinical Manifestations ◽  
Streptococcal Pharyngitis ◽  
Penicillin G ◽  
Benzathine Penicillin ◽  
Cure Rate ◽  
Penicillin V ◽  
Significant Difference ◽  
Penicillin Therapy ◽  
Benzathine Penicillin G ◽  
Oral Doses

The effectiveness of penicillin V, penicillin V potassium, benzathine penicillin G, erythromycin and tetracycline in eradicating beta-hemolytic streptococci from the pharynx of 410 infected patients or carriers was studied. Penicillin V and penicillin V potassium were administered in daily oral doses of 375 to 750 mg (600,000 and 1,200,000 units), respectively, for 10 days. The benzathine penicillin G was injected once intramuscularly in similar doses. The broad spectrum antibiotics were given in daily oral doses of 30 to 50 mg/kg, up to 1 gm, for 10 days. The bacterial cure rate was 84% for 224 patients treated with penicillin V and penicillin V potassium, and 86% for 129 patients treated with benzathine penicillin G in combined doses. Forty-eight percent of 23 patients treated with erythromycin and 38% of 34 patients treated with tetracycline were cured. The majority of the clinical bacterial relapses developed 14 to 28 days after the onset of treatment with penicillin V orally and 24 to 32 days after benzathine penicillin G, 375 mg intramuscularly. Approximately half of the patients with bacterial relapses had clinical manifestations of pharyngitis. Factors which might be responsible for the development of relapses and failures are discussed. Complications consisted of one case of otitis media and one case of glomerulonephritis, developing 12 and 22 days, respectively, after the onset of treatment. No case of rheumatic fever was observed. The data indicate that penicillin was definitely more effective than erythromycin and tetracycline in eradiating beta-hemolytic streptococci from the host, in the doses used. There was no significant difference in the effectiveness of penicillin V, penicillin V potassium and benzathine penicillin G. Attention is drawn to the relapse-and-failure rate of 15% in these patients despite penicillin therapy.

A Review of the Rationale and Advantages of Various Mixtures of Benzathine Penicillin G

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 960-963
Author(s):  
James W. Bass
Keyword(s):  
Clinical Response ◽  
Gold Standard ◽  
Streptococcal Pharyngitis ◽  
Penicillin G ◽  
Benzathine Penicillin ◽  
Cure Rate ◽  
Parenteral Treatment ◽  
Benzathine Penicillin G ◽  
Local Reactions

Intramuscular benzathine (BZ) penicillin G has been accepted as the gold standard for treatment of patients with streptococcal pharyngitis since it was first introduced in 1952. Unfortunately, it has been associated with pain and tenderness at the site of injection. Efforts to lessen this by combining it with varied quantities of procaine (PC) penicillin G have been successful, decreasing the incidence of significant local reactions to 5% to 10%, little more than that seen with PC penicillin alone. A preparation containing 600 000 U BZ penicillin G and 600 000 U PC penicillin in 2 mL has been marketed since the mid-1950s as CR Bicillin 600/600 but the content of BZ penicillin G has been considered adequate only for children who weigh <60 pounds. This prompted the evaluation of a preparation containing 900 000 U BZ penicillin G plus 300 000 U PC penicillin G in a 2-mL injection. Of 400 children with streptococcal pharyngitis 100 each received this preparation, 600 000 U BZ penicillin G alone in 1 mL, 1.2 million U BZ penicillin G alone in 2 mL or 600 000 U BZ penicillin G plus 600 000 U PC penicillin G in 2 mL Clinical response was equal in all four groups; all patients were well in 36 to 48 hours. The two preparations containing PC penicillin G had significantly less severe local reactions and throat cultures were negative in all by 48 hours; it remained positive in some patients who received BZ penicillin G alone after 72 hours. The cure rate in patients receiving the 900 000/300 000 combination of BZ and PC penicillin G was equal to that in patients who received 1.2 million U BZ penicillin G with these added advantages. This combination offers optimal parenteral treatment for streptococcal pharyngitis in all children who weigh <140 pounds and it has been marketed for this purpose since 1976.

Aseptic myonecrosis following intramuscular benzathine penicllin G injection: a novel syndrome

Diagnosis ◽  
2017 ◽  
Vol 4 (1) ◽  
pp. 51-54 ◽  
Author(s):  
Nicholas Ryan ◽  
Andrew Olson
Keyword(s):  
Side Effects ◽  
Injection Site ◽  
Pediatric Patient ◽  
Similar Case ◽  
Streptococcal Pharyngitis ◽  
Penicillin G ◽  
Injection Site Pain ◽  
Benzathine Penicillin ◽  
Benzathine Penicillin G ◽  
Site Pain

AbstractWe report a novel syndrome of aseptic myonecrosis in a child occurring after intramuscular (IM) benzathine penicillin G injection for the treatment of streptococcal pharyngitis. Common side effects of IM injection, including transient injection site pain and inflammation, are common and well described. However, isolated myonecrosis following IM injection in the pediatric patient has not been previously reported. Only one similar case, following IM diclofenac injection, has been discussed in the adult literature.

Efficacy of benzathine penicillin G in group A streptococcal pharyngitis: Reevaluation

1987 ◽  
Vol 110 (5) ◽  
pp. 783-787 ◽  
Author(s):  
Sandor Feldman ◽  
Alan L. Bisno ◽  
Lennie Lott ◽  
Richard Dodge ◽  
Rachel E. Jackson
Keyword(s):  
Streptococcal Pharyngitis ◽  
Penicillin G ◽  
Benzathine Penicillin ◽  
Benzathine Penicillin G ◽  
Group A

Pharmacokinetics of Rheumatic Fever Prophylaxis Regimens

1992 ◽  
Vol 20 (1) ◽  
pp. 20-26 ◽  
Author(s):  
V Thamlikitkul ◽  
S Kobwanthanakun ◽  
S Pruksachatvuthi ◽  
R Lertluknithi
Keyword(s):  
Rheumatic Fever ◽  
Crossover Design ◽  
Penicillin G ◽  
Benzathine Penicillin ◽  
Serum Samples ◽  
Once Daily ◽  
Penicillin V ◽  
Benzathine Penicillin G ◽  
Erythromycin Stearate ◽  
Alternative Regimen

The pharmacokinetics of benzathine penicillin G (1200000 IU given intramuscularly), penicillin V (250 mg given orally twice daily), erythromycin stearate (250 mg given orally twice daily) and roxithromycin (150 mg given orally once daily) were investigated. The drugs were given prophylactically to prevent the recurrence of rheumatic fever to 20 patients attending a rheumatic fever clinic in a study of crossover design. Serum antibiotic concentrations were determined by microbiological assay at intervals of up to 28 days after intramuscular injection and immediately before and 1–2 h after the fifth oral dose. The concentrations of penicillin G in all serum samples obtained on day 28 after parenteral benzathine penicillin G administration were greater than 0.01 mg/dl. Most patients had no detectable penicillin V or erythromycin in blood samples drawn immediately before the fifth dose. The concentration of roxithromycin at 24 h after the dose was greater than 1.2 mg/dl in all patients. Based on the pharmacokinetic profiles, it is suggested that 1200000 IU benzathine penicillin G given every 4 weeks is an appropriate regimen for preventing the recurrence of rheumatic fever in Thai adults. Roxithromycin had much better pharmacokinetics than penicillin V and erythromycin stearate, and is probably the best alternative regimen to intramuscular penicillin G.

OBSERVATIONS ON AN EPIDEMIC OF STREPTOCOCCAL INFECTIONS AND RECURRENCES OF RHEUMATIC FEVER AMONG CHILDREN TREATED WITH PENICILLIN

PEDIATRICS ◽  
1957 ◽  
Vol 20 (2) ◽  
pp. 257-267
Author(s):  
Milton Markowitz
Keyword(s):  
Oral Dose ◽  
Rheumatic Fever ◽  
Streptococcal Pharyngitis ◽  
Penicillin G ◽  
Streptococcal Infections ◽  
Benzathine Penicillin ◽  
Daily Oral Dose ◽  
Intramuscular Dose ◽  
Small Series ◽  
Benzathine Penicillin G

An outbreak of streptococcal pharyngitis among children in a convalescent hospital has been described. Eleven of thirty-three subjects with rheumatic fever, under close observation, developed group A streptococcal infections while they received a single daily oral dose of 200,000 units of benzathine penicillin G. Treatment of the streptococcal infections was carried out with therapeutic doses of various penicillin preparations. Four children who received single injections of 600,000 units of benzathine penicillin G, developed recurrences of rheumatic fever. The results of the study indicate that a single daily oral dose of 200,000 units of benzathine penicillin G is inadequate for the prevention of streptococcal infections in a closed or semiclosed community of rheumatic fever subjects. It is suggested that at least twice this dosage be employed in such an environment. The data based on a small series of cases suggest that the treatment of acute streptococcal infections with a single intramuscular dose of 600,000 units of benzathine penicillin G will not prevent recurrences of rheumatic fever in highly susceptible patients.

CONCENTRATION OF PENICILLIN IN THE SERUM FOLLOWING INTRAMUSCULAR ADMINISTRATION OF BENZATHINE PENICILLIN G TO CHILDREN WITH INACTIVE RHEUMATIC FEVER

PEDIATRICS ◽  
1958 ◽  
Vol 21 (2) ◽  
pp. 233-242
Author(s):  
Roswith I. Lade ◽  
Antoni M. Diehl ◽  
Irvin Snyder ◽  
Tom R. Hamilton
Keyword(s):  
Rheumatic Fever ◽  
Positive Culture ◽  
Significant Rise ◽  
Penicillin G ◽  
Benzathine Penicillin ◽  
Beta Hemolytic Streptococcus ◽  
Significant Difference ◽  
Benzathine Penicillin G ◽  
Group A ◽  
Nose And Throat

Ninety-six children between the ages of 4 and 20 years with inactive rheumatic fever received 1,200,000 units of benzathine penicillin G every 28 days by intramuscular injection and were studied from the standpoint of effective and consistent concentrations of penicillin in the serum. The concentrations of penicillin in the serum could be determined with certainty in 81% of the specimens; concentrations ranged from 0.002 to 0.125 unit/ml. The mean concentration of penicillin reached in the serum of females was three times higher than in males. The concentration of penicillin in the serum of females increased with age and weight from the tenth to the seventeenth years. No such increase was observed in the sera of males in relation to age and weight. The differences in concentration of penicillin reached in the sera of the two sexes from 12 through 17 years of age were statistically significant (p less than 0.01). No significant difference in concentration of penicillin in the serum was found in comparing obese and thin girls of 10 through 15 years of age. The explanation for the differences between the two sexes is not apparent. During the period of the study, 491 swabs from the nose and throat yielded only one positive culture for beta hemolytic streptococcus of group A; this organism could not be typed and was not associated with an increase in the titer of antistreptolysin O. One other patient had a significant rise in antibody titer, but there was no antecedent positive culture for streptococcus. There were no recurrences of rheumatic fever.

Sign in / Sign up

Export Citation Format

Share Document