Diagnosis and rational antibiotic therapy of group A streptococcal infections as the basis for the primary prevention of acute rheumatic fever

Abstract

Acute tonsillitis caused by group A b-hemolytic streptococcus (GABHS) remains a challenge both for doctors and the healthcare in general. The article provides evidence of the revival of the highly virulent GABHS infection and the growing incidence of complications (acute rheumatic fever, toxic shock syndrome), and substantiates the need for rational antibiotic therapy of the disease. The drugs of choice for the treatment of acute GABHS tonsillitis are penicillins (amoxicillin, benzathine penicillin, phenoxymethylpenicillin) and 1st-generation cephalosporins (cefadroxil), and, in case of intolerance, b-lactam antibiotics - macrolides. In case of chronic recurrent GABHS tonsillitis, when the risk of colonization of the focal point by microorganisms producing b-lactamase is quite high, inhibitor-protected penicillins (amoxicillin-clavulanate) or 2nd- or 3rd-generation cephalosporins (cefuroxime axetil, cefixime) are administered. Lincosamides (lincomycin, clindamycin) are used in the treatment of acute and chronic GABHS tonsillitis as reserve antibiotics.