title: Outcomes in children treated for perineal group A beta-hemolytic streptococcal dermatitis.
abstract: OBJECTIVE
  To evaluate reports that describe relapse or recurrence following treatment of perineal streptococcal dermatitis (PSD), we studied a large cohort of children with these perianal or perivaginal infections to determine whether outcomes are related to the antimicrobial agent selected for initial treatment.
  
  
  METHODS
  We audited laboratory logs and medical records to retrospectively identify incident cases of culture-confirmed PSD in children at a large university-affiliated health system during 2006-2008. We estimated rates of recurrence (defined as any return visit with a clinical diagnosis of perineal dermatitis within 6 months) and, then, incorporated these rates into a meta-analysis that included 8 previous studies.
  
  
  RESULTS
  A total of 81 children had incident PSD during the study period, and 26 (32.1%) had a recurrence. Most (18/26 [69.2%]) had their first recurrence within 6 weeks. Among children treated with an oral agent, the recurrence rate was 16/42 (38.1%) following penicillin or amoxicillin and 10/36 (27.8%) following a beta-lactamase resistant agent (adjusted odds ratio: 2.02 [95% confidence interval {CI}: 0.69-5.92]). In the meta-analysis, recurrence rates following penicillin or amoxicillin were consistent across studies (fixed-effect test for heterogeneity, P = 0.35), and the pooled rate (37.4% [95% CI: 28.8%-46.5%]) was higher than observed following a beta-lactamase resistant agent (odds ratio: 2.39 [95% CI: 1.18-4.81]).
  
  
  CONCLUSIONS
  Perineal streptococcal dermatitis initially treated with penicillin or amoxicillin is consistently associated with a high risk of clinical recurrence. Whether treatment with a beta-lactamase resistant agent reduces this risk is uncertain and should be subjected to a clinical trial.
authors: Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: Dan
authors: D
authors: Olson
authors: M Bruce
authors: MB
authors: Edmonson
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D001003:Anal Canal / Q000187:drug effects* / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003872:Dermatitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use; D010413:Penis / Q000187:drug effects* / Q000382:microbiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D013291:Streptococcus / Q000187:drug effects* / Q000502:physiology; D016896:Treatment Outcome; D014621:Vagina / Q000187:drug effects* / Q000382:microbiology; D014922:Wisconsin / Q000453:epidemiology; D001618:beta-Lactamases / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D000658:Amoxicillin; C039404:beta-lactamase OXA-2; D001618:beta-Lactamases