INVASIVE GROUP-A STREPTOCOCCAL INFECTION - NEW CONCEPTS IN ANTIBIOTIC-TREATMENT

The incidence of severe group A streptococcal infection and the strept ococcal toxic shock syndrome has increased since 1986. In contrast to earlier times, aggressive streptococcal infection is now more likely t o affect patients between 20 and 50 years of age who do not have predi sposing underlying diseases. Its viral-like prodrome can often mislead clinicians and patients, and nonsteroidal anti-inflammatory drugs can mask symptoms. Prompt antibiotic therapy is mandatory, but even with aggressive treatment mortality may be 30-50%. Though penicillin is the drug of choice for most streptococcal infections, its efficacy is poo r in deep-seated soft-tissue infections, and is in part related to the in vivo inoculum effect and 'the physiologic state of the organism'. This paper reviews the molecular mechanisms responsible for these phen omena and demonstrates the greater efficacy of clindamycin in an exper imental model of severe streptococcal infection.