title: Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection.
abstract: BACKGROUND
  Animal model studies have demonstrated the failure of penicillin to cure Streptococcus pyogenes myositis and have suggested that clindamycin is a more effective treatment.
  
  
  OBJECTIVE
  To determine the most effective antibiotic treatment for invasive S. pyogenes infection in humans.
  
  
  METHODS
  We conducted a retrospective review of the outcomes of all inpatients from 1983 to 1997 treated for invasive S. pyogenes infection at Children's Hospital.
  
  
  METHODS
  Fifty-six children were included, 37 with initially superficial disease and 19 with deep or multiple tissue infections.
  
  
  METHODS
  Lack of progression of disease (or improvement) after at least 24 h of treatment.
  
  
  RESULTS
  The median number of antibiotic exposures was 3 per patient (range 1 to 6) with clindamycin predominating in 39 of 45 courses of protein synthesis-inhibiting antibiotics and beta-lactams predominating amongst the cell wall-inhibiting antibiotics in 123 of 126 of the remainder. Clindamycin was often used in combination with a beta-lactam antibiotic. Overall there was a 68% failure rate of cell wall-inhibiting antibiotics when used alone. Patients with deep infection were more likely to have a favorable outcome if initial treatment included a protein synthesis-inhibiting antibiotic as compared with exclusive treatment with cell wall-inhibiting antibiotics (83% vs. 14%, P = 0.006) with a similar trend in those with superficial disease (83% vs. 48%, P = 0.07). For those children initially treated with cell wall-inhibiting antibiotics alone, surgical drainage or debridement increased the probability of favorable outcome in patients with superficial disease (100% vs. 41%, P = 0.04) with a similar trend in a smaller number of deep infections (100% vs. 0%, P = 0.14).
  
  
  CONCLUSIONS
  This retrospective study suggests that clindamycin in combination with a beta-lactam antibiotic (with surgery if indicated) might be the most effective treatment for invasive S. pyogenes infection.
authors.affiliation: Department of Pediatrics, The University of Colorado School of Medicine, Denver, USA.
authors.forename: J
authors.initials: J
authors.lastname: Zimbelman
authors.forename: A
authors.initials: A
authors.lastname: Palmer
authors.forename: J
authors.initials: J
authors.lastname: Todd
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use*; D019115:Fasciitis, Necrotizing / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000188:drug therapy*; D013297:Streptococcus pyogenes; D047090:beta-Lactams
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D002981:Clindamycin