Variables influencing bacteriological outcome in patients with streptococcal tonsillopharyngitis treated with penicillin V.
Despite the fact that group A streptococci (GAS) remain susceptible to penicillin V (pen V), an increasing rate of bacteriological treatment failures has occurred. A recent study has suggested that the major variables associated with pen V treatment failures were the number of days ill prior to initiation of treatment (<2 days) and age <6 years. In order to study the link between pen V treatment failures and individual variables, we reviewed the files of all children enrolled in four randomised multicentre trials of oral antibiotic therapy, carried out from 1993 to 1999. A standard protocol and follow-up examination were used in these four studies: cultures were obtained 4 days and 1 month after completion of treatment. Total DNA restriction fragment length polymorphism was used to compare pre- and post-treatment GAS isolates. We enrolled 1560 children aged 3 to 12 years, 685 received a 10 day pen V regimen (45 mg/kg per day divided into three doses/day), among them 536 were assessable for bacteriological efficacy at the first and second follow-up visit. We found the only variable associated with penicillin treatment failure was the age of the child when infected. The rate of failure was statistically more important for children younger than 6 years (35.5%, 95% CI 29.9--41.1) than for older children (21.9%, 95% CI 16.9-26.9).


CONCLUSIONS
in this study only young age (<6 years) increases penicillin V treatment failures for group A streptococcal tonsillopharyngitis. This may lead to different antibiotic regimens and follow-up modalities for these targeted patients.
Ovetchkine
Philippe
P
Department of Paediatrics, Créteil Hospital, Paris, France. Activ@wanadoo.fr
Levy
Corinne
C
de la Rocque
France
F
Boucherat
Michel
M
Bingen
Edouard
E
Cohen
Robert
R
D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004334:Drug Administration Schedule; D004352:Drug Resistance, Microbial; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D010404:Penicillin V / Q000008:administration & dosage*; D010612:Pharyngitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D011336:Probability; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy*; D013297:Streptococcus pyogenes / Q000187:drug effects* / Q000302:isolation & purification; D014069:Tonsillitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
D010404:Penicillin V