title: A pilot study of penicillin prophylaxis for neuropsychiatric exacerbations triggered by streptococcal infections.
abstract: BACKGROUND
  Some children with obsessive-compulsive disorder (OCD) and tic disorders appear to have symptom exacerbations triggered by group A beta-hemolytic streptococcal infections in a manner that is similar to rheumatic fever and its neurologic variant, Sydenham's chorea. Because penicillin prophylaxis has proven to be effective in preventing recurrences of rheumatic fever, it was postulated that it might also prevent streptococcal-triggered neuropsychiatric symptom exacerbations in children with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS). These children are identified by five clinical characteristics: presence of OCD or tic disorder, prepubertal onset, episodic symptom course, neurologic abnormalities (i.e., choreiform movements) and streptococcal-triggered symptom exacerbations.
  
  
  METHODS
  Thirty-seven children with PANDAS were enrolled in an 8 month, double-blind, balanced cross-over study. Patients were randomized to receive either 4 months of the active compound (twice daily oral 250 mg penicillin V) followed by 4 months of placebo, or placebo followed by penicillin V. Tic, OCD, and other psychiatric symptoms were monitored monthly. Throat cultures and streptococcal antibody titers were also obtained.
  
  
  RESULTS
  There were an equal number of infections in both the active and placebo phases of the study. There was no significant change seen in either the obsessive-compulsive or tic symptom severity between the two phases.
  
  
  CONCLUSIONS
  Because of the failure to achieve an acceptable level of streptococcal prophylaxis, no conclusions can be drawn from this study regarding the efficacy of penicillin prophylaxis in preventing tic or OCD symptom exacerbations. Future studies should employ a more effective prophylactic agent, and include a larger sample size.
authors.affiliation: Pediatrics and Developmental Neuropsychiatry Branch, National Institutes of Mental Health, Bethesda, MD, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Garvey
authors.forename: S J
authors.initials: SJ
authors.lastname: Perlmutter
authors.forename: A J
authors.initials: AJ
authors.lastname: Allen
authors.forename: S
authors.initials: S
authors.lastname: Hamburger
authors.forename: L
authors.initials: L
authors.lastname: Lougee
authors.forename: H L
authors.initials: HL
authors.lastname: Leonard
authors.forename: M E
authors.initials: ME
authors.lastname: Witowski
authors.forename: B
authors.initials: B
authors.lastname: Dubbert
authors.forename: S E
authors.initials: SE
authors.lastname: Swedo
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000382:microbiology* / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D003866:Depressive Disorder / Q000382:microbiology* / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007769:Lactams; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology; D010406:Penicillins / Q000627:therapeutic use*; D010865:Pilot Projects; D012213:Rheumatic Fever / Q000517:prevention & control; D055502:Secondary Prevention; D013290:Streptococcal Infections / Q000150:complications*; D013981:Tic Disorders / Q000175:diagnosis / Q000523:psychology
chemical_list: D000900:Anti-Bacterial Agents; D007769:Lactams; D010406:Penicillins