Those children that you are not eradicating the streptococci in are probably
carriers. Thecarrier state is problematic because it is difficult to
ascertain whether the child is symptomatic from the GAS or a superimposed
viral upper respiratory infection. As you noted, these children become
symptomatic in spite of adequate therapy with penicillin. An alternative
regimen for this situation is Clindamycin. Some propose the use of
Penicillin with Rifampen administered the last 4 days of the 10 day course.
The issue of beta-lactamase organisms interfering with the treatment regimen
has been proven not to be the case in my opion. In children who are
penicillin allergic, erythromycin is the drug of choice. Although in some
parts of the world, Erythomycin has been found to be resistant to
streptococci, accounting for some treatment failures. This does not seem to
be the case in the United States. Again, Penicillin resistant GAS have not
been documented in this country to date.
> It has yet to be documented because we don't test routinely for Pen
>resistance with GABHS. Our ID dept. now recommends using Cephalexin or
>another ceph. if unable to clear Strep. from a symptomatic child using Pen.
>Also, our micro lab is reporting that > 10% of pneumococcus isolates are
>moderately resistant to pen and cephalosporins, thus requiring us to use
>Vancomycin for serious infections.
>111 Michigan Ave, NW
>Washington, DC 20010
>(202) 884-3253 OFC
>(202) 884-3573 FAX
>[log in to unmask]
>On Mon, 3 Jul 1995, Jim Lindsay wrote:
>> On Mon, 3 Jul 1995, DAVID G. WARD (901) 572-3010 wrote:
>> > Gilbert Z. Given,
>> > <Where is the data for all this Pen-resistant Group A Streptococcus?
>> > I'm not sure I specified GABHS. In Memphis we have, I think,
>> > pneumococcus resistant to pen. I'll check with ID and get back to you
>> > with more info. I'm out of town for the next week or so, though.
>> I was just reading through the June 1995 Pediatric Clinics of North
>> America titled Antimicrobial Resistance in Pediatrics. There is a
>> chapter on Antibiotic Resistance in Group A Streptococci pp 539-551. They
>> state "an isolate of GABHS that is resistant to penicillin has yet to be
>> documented." The author goes on to state, "mutants exhibiting elevated
>> MIC values for penicillin have been produced in the laboratory." So
>> maybe it will just be a matter of time for this to occur, but it hasn't yet.
>> Jim Lindsay, MD CAlifornia Pacific Med Center, San Francisco, CA
Gilbert Z. Given, M.D.
Associate Professor of Clinical Pediatrics
University of Chicago
[log in to unmask]