Bacteriological and clinical efficacy of various antibiotics used in the treatment of streptococcal pharyngitis in Italy. An epidemiological study

Citation
G. Rondini et al., Bacteriological and clinical efficacy of various antibiotics used in the treatment of streptococcal pharyngitis in Italy. An epidemiological study, INT J ANT A, 18(1), 2001, pp. 9-17
Citations number
30
Categorie Soggetti
Microbiology
Journal title
INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS
ISSN journal
09248579 → ACNP
Volume
18
Issue
1
Year of publication
2001
Pages
9 - 17
Database
ISI
SICI code
0924-8579(200107)18:1<9:BACEOV>2.0.ZU;2-2
Abstract
A total of 123 community paediatricians and 23 microbiology laboratories st udied the clinical and bacteriological efficacy of treatment of group A str eptococcal pharyngitis in Italy. Of 1065 patients, from whom Streptococcus pyogenes was isolated, 723 returned to follow up and of these 138 (19%) sti ll had a positive throat culture. The erythromycin resistance (ER) rate was 23.7% with resistance phenotype distribution of: 31.7% constitutive (CR), 26.6% inducible (IR) and 41.7% efflux pump (M) resistance phenotype. All st rains were susceptible to the beta -lactam agents tested. CR strains were h ighly resistant to all 14, 15 and 16 membered macrolides with the exception of rokitamycin which showed activity against 37.8% of isolates. All phenot ype M and some IR isolates were susceptible to clindamycin, rokitamycin, jo samycin and spiramycin; clarithromycin was active against a small percentag e of strains belonging to the IR and M phenotype. Bacterial eradication was found in 85.5, 78.7 and 75.8%, of the penicillin, macrolide and cephalospo rin treated groups. Genotyping of strains showed that 8.7% of the 19%, of c ases classified as 'failed bacterial eradication' were due to recolonizatio n with a different isolate, observed exclusively among beta -lactams treate d patients. Clinical cure was achieved in a high percentage of cases, irres pective of the antibiotic prescribed, with the best clinical efficacy being found following therapy with amoxycillin and clarithromycin (90.9%). (C) 2 001 Elsevier Science B.V. and International Society of Chemotherapy. All ri ghts reserved.