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Variables influencing bacteriological outcome in patients with streptococcal tonsillopharyngitis treated with
Philippe Ovetchkine1, Corinne Levy, France de la Rocque
1Department of Paediatrics, Créteil Hospital, Paris, France. Activ@wanadoo.fr
Unlabelled:
Despite the fact that group A streptococci (GAS) remain susceptible to penicillin V (pen V), an increasing rate of bacteriological treatment failures has occurred. A recent study has suggested that the major variables associated with pen V treatment failures were the number of days ill prior to initiation of treatment (<2 days) and age <6 years. In order to study the link between pen V treatment failures and individual variables, we reviewed the files of all children enrolled in four randomised multicentre trials of oral antibiotic therapy, carried out from 1993 to 1999. A standard protocol and follow-up examination were used in these four studies: cultures were obtained 4 days and 1 month after completion of treatment. Total DNA restriction fragment length polymorphism was used to compare pre- and post-treatment GAS isolates. We enrolled 1560 children aged 3 to 12 years, 685 received a 10 day pen V regimen (45 mg/kg per day divided into three doses/day), among them 536 were assessable for bacteriological efficacy at the first and second follow-up visit. We found the only variable associated with penicillin treatment failure was the age of the child when infected. The rate of failure was statistically more important for children younger than 6 years (35.5%, 95% CI 29.9--41.1) than for older children (21.9%, 95% CI 16.9-26.9).
Conclusion:
in this study only young age (<6 years) increases penicillin V treatment failures for group A streptococcal tonsillopharyngitis. This may lead to different antibiotic regimens and follow-up modalities for these targeted patients.
Insights
Penicillin V treatment failures in group A streptococcal infections are higher in children younger than 6 years old. This finding suggests tailored antibiotic strategies may be needed for this age group.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Group A streptococci (GAS) infections remain susceptible to penicillin V (pen V).
- An increasing rate of bacteriological treatment failures with pen V has been observed.
- Previous studies suggested age and duration of illness influence treatment outcomes.
Purpose of the Study:
- To investigate individual variables associated with penicillin V treatment failures in pediatric GAS tonsillopharyngitis.
- To identify specific patient groups at higher risk for treatment failure.
Main Methods:
- A retrospective analysis of children from four randomized multicenter trials (1993-1999).
- Included 1560 children aged 3-12 years, with 685 receiving a 10-day pen V regimen.
- Bacteriological efficacy assessed via cultures at 4 days and 1 month post-treatment; GAS isolates compared using DNA fingerprinting.
Main Results:
- The only significant variable associated with penicillin treatment failure was younger age.
- Children under 6 years old had a higher failure rate (35.5%) compared to older children (21.9%).
Conclusions:
- Young age (<6 years) is a key factor increasing penicillin V treatment failures in GAS tonsillopharyngitis.
- This highlights the need for potentially different antibiotic regimens and follow-up strategies for young children.