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Clindamycin in persisting streptococcal pharyngotonsillitis after penicillin treatment
A Orrling1, A Stjernquist-Desatnik, C Schalén
1Department of Oto-Rhino-Laryngology, University Hospital, Lund, Sweden.
Abstract:
239 patients with streptococcal pharyngotonsillitis completed treatment with phenoxymethyl penicillin 12.5 mg per kg body weight b.i.d. for 10 days. At examination after completing therapy, throat specimens from 53 patients (22%) yielded growth of group A streptococci of the same. T-type as the initial culture (bacterial treatment failure). 20 of these 53 (38%) had symptoms and signs of tonsillitis (clinical and bacterial treatment failure). 48 of the patients with bacterial failure were randomly allocated to phenoxymethyl penicillin or clindamycin in an open design; 22 of them received a second course of phenoxymethyl penicillin for 10 days and 26 were given clindamycin, 6.5 mg per kg body weight b.i.d. (children) or 300 mg t.i.d. (adults) for 10 days. After completing their treatment, 14 of 22 patients (64%) given phenoxymethyl penicillin harboured the same T-type as in the previous two cultures, while group A streptococci were not recovered from any of the 26 patients receiving clindamycin. In patients with clinical failure after phenoxymethyl penicillin treatment, a new course with this drug is not motivated. In that situation clindamycin seems to be an efficient choice.
Insights
Phenoxymethyl penicillin treatment for streptococcal pharyngotonsillitis can lead to treatment failure. Clindamycin is an effective alternative when phenoxymethyl penicillin fails, especially in cases with persistent symptoms.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Streptococcal pharyngotonsillitis is a common bacterial infection.
- Phenoxymethyl penicillin is a standard treatment, but resistance can occur.
- Treatment failure necessitates exploring alternative therapies.
Purpose of the Study:
- To evaluate the efficacy of phenoxymethyl penicillin retreatment versus clindamycin for persistent group A streptococcal pharyngotonsillitis.
- To determine the optimal treatment strategy for bacterial and clinical treatment failures.
Main Methods:
- 239 patients with streptococcal pharyngotonsillitis received initial phenoxymethyl penicillin treatment.
- Bacterial treatment failures were reassessed and randomly assigned to a second course of phenoxymethyl penicillin or clindamycin.
- Treatment outcomes were assessed by bacterial culture and clinical signs.
Main Results:
- 22% of patients experienced bacterial treatment failure with initial phenoxymethyl penicillin.
- Of those with bacterial failure, 38% had persistent clinical symptoms.
- Retreatment with phenoxymethyl penicillin showed a 64% failure rate, while clindamycin achieved a 0% failure rate in eradicating group A streptococci.
Conclusions:
- A second course of phenoxymethyl penicillin is not recommended for patients with clinical failure.
- Clindamycin demonstrates high efficacy in treating persistent group A streptococcal pharyngotonsillitis after initial phenoxymethyl penicillin failure.