title: Treatment failure in streptococcal pharyngotonsillitis. An attempt to identify penicillin tolerant Streptococcus pyogenes.
abstract: Penicillin tolerance in group A streptococci has been suggested to cause treatment failures in pharyngotonsillitis. In the present study, group A streptococci from patients with pharyngotonsillitis, who healed (n = 33) or failed (n = 25) on phenoxymethylpenicillin therapy for 10 days, as well as isolates obtained following the first (n = 25) and second (n = 7) failure were tested for penicillin tolerance by a plate-screening method. For most strains, the survival rate after a 6-h exposure of log-phase bacteria (10(4) CFU) to a phenoxymethylpenicillin concentration of 4 times the minimum inhibitory concentration (MIC) was below 0.1%. Five strains from cases of failure, exhibiting survival rates of 0.2-0.5%, were subjected to time killing kinetic tests with phenoxymethylpenicillin at 12 times the MIC. At 6 h each of the strains from failures showed survival rates below 0.03%. One single group A strain, previously selected in our laboratory, showed a survival rate of 0.4-1.2%, which was close to tolerance as defined. Four streptococcal strains, earlier reported as tolerant, showed survival rates of > 1% but were found to be group G. Penicillin tolerance does not significantly contribute to failures in penicillin therapy of group A streptococcal pharyngotonsillitis, but seems to be a common property of group C and G streptococci.
authors.affiliation: Department of Oto-Rhino-Laryngology, University Hospital, Lund, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Orrling
authors.forename: A
authors.initials: A
authors.lastname: Stjernquist-Desatnik
authors.forename: C
authors.initials: C
authors.lastname: Schalén
authors.forename: C
authors.initials: C
authors.lastname: Kamme
mesh_terms: D015169:Colony Count, Microbial; D004305:Dose-Response Relationship, Drug; D004352:Drug Resistance, Microbial; D006801:Humans; D008826:Microbial Sensitivity Tests; D010403:Penicillin Resistance; D010612:Pharyngitis / Q000188:drug therapy / Q000382:microbiology; D013290:Streptococcal Infections / Q000188:drug therapy*; D013297:Streptococcus pyogenes / Q000187:drug effects* / Q000302:isolation & purification; D014069:Tonsillitis / Q000188:drug therapy / Q000382:microbiology; D017211:Treatment Failure