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Incidence of streptococcal carriers in private pediatric practice
M E Pichichero1, S M Marsocci, M L Murphy
1Department of Microbiology and Immunology, University of Rochester Medical Center, NY 14642, USA. mepo@uhura.cc.rochester.edu
Insights
Group A beta-hemolytic streptococcus (GABHS) carriage is low in well children and those with viral sore throats. Penicillin treatment for GABHS tonsillopharyngitis leads to higher carriage rates compared to cephalosporins or macrolides.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Clinical epidemiology
Background:
- Group A beta-hemolytic streptococcus (GABHS) is a common bacterial pathogen causing tonsillopharyngitis in children.
- Understanding GABHS carrier rates is crucial for effective treatment and prevention of complications.
- Antibiotic selection may influence post-treatment GABHS carriage rates.
Purpose of the Study:
- To determine the incidence of GABHS carriers in asymptomatic children, those with viral sore throats, and after antibiotic treatment for GABHS tonsillopharyngitis.
- To compare GABHS carriage rates following treatment with penicillin, cephalosporins, and macrolides.
Main Methods:
- Prospective collection of clinical and microbiologic data from a private pediatric practice.
- Data gathered from well children, children with presumed/documented viral sore throats, and children completing antibiotic treatment for GABHS tonsillopharyngitis.
- Analysis of GABHS carrier status based on different clinical presentations and treatment regimens.
Main Results:
- GABHS carrier rates were 2.5% in well children, 4.4% in presumed viral sore throats, and 6.9% in documented viral sore throats.
- Post-treatment GABHS carriage rates were 11.3% with penicillin, 4.3% with cephalosporins, and 7.1% with macrolides (P<.001).
- Penicillin treatment resulted in significantly higher GABHS carriage rates compared to cephalosporins and macrolides.
Conclusions:
- A small proportion of children in pediatric practices are GABHS carriers, even when asymptomatic or with viral infections.
- Penicillin treatment for GABHS tonsillopharyngitis is associated with a higher incidence of GABHS carriage than cephalosporin or macrolide treatment.
- Antibiotic choice may impact GABHS eradication and subsequent carriage in pediatric populations.
Objective:
To determine the incidence of group A beta-hemolytic streptococcus (GABHS) carriers in children who are well, in children seen with presumed and documented viral illnesses with sore throat, and in children after treatment of acute GABHS tonsillopharyngitis with 10 days of oral penicillin V potassium, oral cephalosporins, or macrolides.
Methods:
Prospective collection of clinical and microbiologic data from October 1996 to June 1997 in a private pediatric practice were obtained from children who were asymptomatic and well, from children with both presumed (and documented) viral sore throats, and from children who had completed a full antibiotic treatment course for acute GABHS throat infections.
Results:
The incidence of GABHS carriers was 2.5% among well children (n = 227), 4.4% among children with upper respiratory tract infections including sore throat of presumed viral etiology (n= 296), and 6.9% among children with upper respiratory tract infections including sore throat from whom viruses were isolated (n = 87). Following 10 days' treatment of acute GABHS tonsillopharyngitis, 81 (11.3%) of 718 children treated with penicillin, 22 (4.3%) of 508 children treated with an oral cephalosporin, and 10 (7.1%) of 140 children treated with a macrolide were GABHS carriers (P<.001).
Conclusions:
A small percentage of children seen in private pediatric practices who are well or who have apparent viral upper respiratory tract infections with sore throat are GABHS carriers. Penicillin treatment of acute GABHS tonsillopharyngitis results in a higher GABHS carriage rate than occurs following treatment with cephalosporins and macrolides.