PERSISTENCE OF GROUP-A BETA-HEMOLYTIC STREPTOCOCCI IN TOOTHBRUSHES AND REMOVABLE ORTHODONTIC APPLIANCES FOLLOWING TREATMENT OF PHARYNGOTONSILLITIS

Objective: To investigate the persistence of group A beta-hemolytic st reptococci (GABHS) in toothbrushes and removable orthodontic appliance s (ROAs) in children who suffer from acute GABHS pharyngotonsillitis a nd the association with penicillin treatment failure. Setting: Private practice setting. Patients and Methods: Pharyngotonsillar and toothbr ush cultures were obtained from 104 children with acute GABHS pharyngo tonsillitis before and after 10 days of penicillin V potassium therapy . Cultures of ROAs were also obtained from 21 children. The persistenc e of GABHS in 10 daily rinsed and 10 nonrinsed toothbrushes was studie d in vitro. Results: Group A beta-hemolytic streptococci were isolated from 11 (11%) of the toothbrushes and 18 (17%) of the patients after the completion of penicillin therapy. Toothbrushes of 5 (28%) of the 1 8 children who harbored GABHS were colonized with the organism. Group A beta-hemolytic streptococci were also isolated from 4 (19%) of 21 RO As after therapy. In vitro studies illustrated the persistence of GABH S in nonrinsed toothbrushes for up to 15 days. In contrast, the organi sm was not isolated from rinsed toothbrushes beyond day 3. Conclusion: Toothbrushes and ROAs that harbor GABHS map contribute to the persist ence of GABHS in the oropharynx and may account for the failure of pen icillin therapy in some cases of pharyngotonsillitis.