[Choice of antibiotic therapy for acute streptococcus A sore throat: new bacteriologic data]

The choice of antibiotic therapy for sore throat of bacterial origin must be directed against the beta-haemolytic streptococcus A, or more rarely C and G. Recent bacteriological data confirm the raised and constant antibacterial activity in vitro of penicillins V and G, with minimal inhibitory concentrations (CMI) as low as 0.01 mg/ml. Until now, there have been no resistant or reduced sensitivity strains reported. Those strains reported as "tolerant" to penicillin are not correlated with therapeutic checks. As for strains of "intermediate sensitivity" to penicillin, these should be attributed to effects of the diffusion techniques. In contrast, in France now, 8% of strains of streptococcus A are resistant to macrolides and 60% to tetracyclines. Finally, new data show that the different selective powers of beta-lactamines, especially cephalosporins, introduce risks of modification of the oro-pharingeal ecology, linked in part with transfer of genetic material between commensal streptococci of reduced sensitivity to beta-lactamines to sensitive pneumococci. All these data emphasize the importance of an antibiotic therapy that is directed to streptococcus A, with a strong and constant bactericidal activity, without risk of selection or appearance of strains of resistant streptococcus A, and that will not disturb the long term bacterial ecology of the oro-pharynx. Now, in 1994 phenoxymethylpenicillin, Oracilline, penicillin V has the place of reference in the treatment of bacterial acute sore throat.