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[Therapeutic strategy for sore throat: current role for targetted antibiotic therapy]
1Service de Pédiatrie, Hôpital Trousseau, Paris.
Insights
Penicillin V (phenoxymethylpenicillin) remains the correct antibiotic for treating beta-haemolytic Streptococcus A infections, effectively preventing serious complications like acute articular rheumatism (RAA). Its targeted approach avoids the ecological risks associated with broad-spectrum antibiotics.
Area of Science:
- Bacteriology
- Infectious Diseases
- Pharmacology
Context:
- Beta-haemolytic Streptococcus A causes most sore throats in children and young adults.
- Preventing serious complications like acute articular rheumatism (RAA) and glomerulonephritis is crucial.
- Recurrence of RAA in the US since 1985 prompted investigations into epidemiology and therapy.
Purpose:
- To evaluate the appropriateness of using broad-spectrum antibiotics versus targeted penicillin therapy for Streptococcus A infections.
- To assess the clinical and bacteriological efficacy of penicillin in preventing RAA.
- To consider the ecological risks of broad-spectrum antibiotic overuse.
Summary:
- Penicillin, specifically phenoxymethylpenicillin (penicillin V), is effective in treating Streptococcus A infections and preventing RAA.
- Concerns exist regarding penicillin's efficacy due to increased carrier rates post-treatment, leading some to suggest broader-spectrum agents.
- International literature supports targeted antibiotic therapy, highlighting penicillin's proven capacity to prevent RAA with a 10-day treatment course.
Impact:
- Recommends phenoxymethylpenicillin (Oracilline, penicillin V) as the appropriate antibiotic for sore throat and Streptococcus A risk in France for 1994.
- Emphasizes the ecological benefits of targeted antibiotic use over broad-spectrum alternatives.
- Supports continued use of penicillin for its proven efficacy and safety profile in preventing rheumatic fever.
Abstract:
The beta-haemolytic streptococcus A, which is responsible for almost all bacterial sore throats in children and young adults, is the target for the first antibiotic treatment. What is really at stake for the treatment is to prevent the serious complications linked with this germ, acute articular rheumatism (RAA) and glomerulonephritis. The recurrence of RAA seen in the United States from 1985, has started many investigations as much for epidemiology as for therapy. Some authors have questioned the treatment with penicillin because of the rise in numbers of carriers of streptococcus A after treatment. They have suggested the use of compounds with a greater spectrum of activity. However, work in the international literature re-states the benefits of a targetted antibio-therapy in this context. Is it appropriate to use a wide spectrum antibiotic to treat an infection of monobacterial target, taking into account the bacteriological and clinical efficacy of penicillin, the only available treatment that has shown its capacity to prevent RAA, with a treatment length of 10 days and which seems to be constant with time? Because of this, faced with the ecological risks of a multi-use of wide range compounds, with a treatment that has not been validated in France, phenoxymethylpenicillin, Oracilline, penicillin V, the antibiotic targetted to sore throat and the streptococcal risk, is correct now for 1994.