10-day Course Of Penicillin Research Articles

Surgical consultation in neonates with congenital syphilis

Abstract Objective The aim was to review the incidence and clinical presentation of neonates with congenital syphilis requiring surgical consultation at a single tertiary neonatal intensive care unit (NICU). Methods Between 2014 and 2016, all records incorporating congenital syphilis and syphilis during pregnancy were obtained to establish disease incidence. During this time, neonates with congenital syphilis and a pediatric surgery consultation were reviewed. Demographic data, details of surgical consultation, operations and clinical outcomes were recorded. Results Between 2014 and 2016, cases of maternal syphilis increased from one to five, and congenital syphilis cases ranged from two to ten. In 2016, four (40%) required surgical consultation. Indications for surgical consultation included: (1) obstructive jaundice, (2) abdominal distension with bilious emesis, (3) distension and hematochezia, and (4) possible anorectal malformation. All were diagnosed by rapid plasma reagin test (RPR) and completed a 10-day course of Penicillin G. One neonate with obstructive jaundice underwent surgery to rule out biliary atresia. Three neonates did not require surgical intervention. Conclusion An understanding of congenital syphilis is imperative for pediatric surgeons. Hepatic and gastrointestinal manifestations may mimic surgical diagnoses in neonates.

What to D.O.

What to D.O.

Influence of the duration of penicillin prescriptions on outcomes for acute sore throat in adults: the DESCARTE prospective cohort study in UK general practice.

Guidelines recommend 10-day treatment courses for acute sore throat, but shorter courses may be used in practice. To determine whether antibiotic duration predicts adverse outcome of acute sore throat in adults in routine care. A secondary analysis of the DESCARTE (Decision rule for the Symptoms and Complications of Acute Red Throat in Everyday practice) prospective cohort study of 12 829 adults presenting in UK general practice with acute sore throat. A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcomes were collected by notes review, a sample also completed a symptom diary. The primary outcome was re-consultation with new/non-resolving symptoms within 1 month. The secondary outcome was 'global' poorer symptom control (longer than the median duration or higher than median severity). Antibiotics were prescribed for 62% (7872/12 677) of participants. The most commonly prescribed antibiotic was phenoxymethylpenicillin (76%, 5656/7474) and prescription durations were largely for 5 (20%), 7 (57%), or 10 (22%) days. Compared with 5-day courses, those receiving longer courses were less likely to re-consult with new or non-resolving symptoms (5 days 15.3%, 7 days 13.9%, 10 days 12.2%, 7-day course adjusted risk ratio (RR) 0.92 [95% confidence interval [CI] = 0.76 to 1.11] and 10-days RR 0.86 [95% CI = 0.59 to 1.23]) but these differences did not reach statistical significance. In adults prescribed antibiotics for sore throat, the authors cannot rule out a small advantage in terms of reduced re-consultation for a 10-day course of penicillin, but the effect is likely to be small.

Acute Poststreptococcal Glomerulonephritis: The Most Common Acute Glomerulonephritis

Acute Poststreptococcal Glomerulonephritis: The Most Common Acute Glomerulonephritis

Pearls in Dermatology: Koebner’s Phenomenon: Skin Trauma May Trigger Psoriatic Flares

An 18-year-old man presented with a 2-week history of erythematous, scaly plaques along his hairline. Streptococcal pharyngitis had been diagnosed using a throat culture 1 month earlier, and the patient had completed a 10-day course of penicillin V potassium. He was concerned that the two conditions were related. His medical history was significant for psoriasis, which had been in remission for several years. The patient denied any other current symptoms or past medical conditions. Physical examination revealed erythematous, scaly plaques on his scalp in addition to his hairline. Further examination revealed several tattoos on his left upper arm, right flank, and upper back. These tattoos had scaly plaques with erythematous bases along many of the ink lines (figure 1). He reported having had these tattoos applied over the previous several months. The remainder of his examination was unremarkable.

Wound Erysipelas Following Appendectomy Caused by Group B Beta-hemolytic Streptococcus (Streptococcus agalactiae)

Case description of a patient who developed erysipelas of the surgical wound following appendectomy for acute appendicitis, and literature review of invasive group B streptococcal infections. A 65-year-old man with perforated appendicitis underwent urgent appendectomy and drainage. Antibiotic prophylaxis with tobramycin (100 mg) and metronidazole (500 mg) was administered. At surgery, a phlegmon was identified with free perforation of the appendix and purulent peritoneal fluid. Appendectomy, irrigation with 0.9% NaCl solution, and drainage with a Silastic closed-suction drain was performed. A literature search in all languages was performed using MEDLINE, using the search terms surgical site infection, wound infection, group B streptococcus, Streptococcus agalactiae, necrotizing fasciitis, and postoperative infection. Erysipelas of the surgical wound developed on the fourth postoperative day. Intravenous penicillin and amoxicillin/clavulanic acid were administered empirically. Culture of the wound drainage identified Streptococcus agalactiae and a few colonies of Escherichia coli. The broad-spectrum antibiotic was discontinued, and a 10-day course of penicillin was completed. Erysipelas of the surgical wound is unusual, and infection with group B streptococci is rare compared with infection by group A streptococci. Streptococcus agalactiae is recognized to be increasingly virulent, with an increasing predilection for bacteremic infections in healthy hosts. Although Streptococcus agalactiae remains highly susceptible to antimicrobial agents effective against gram-positive cocci, the changing epidemiology and potentially invasive nature of these infections should have clinicians alert to the possibility of infection caused by group B streptococci.

Evaluation of Potential Factors Contributing to Microbiological Treatment Failure inStreptococcus PyogenesPharyngitis

A cohort study of children with pharyngitis aged two to 16 years was conducted to assess the role of microbial and host factors in group A beta-hemolytic streptococcus (GABHS) microbiological treatment failure. GABHS-infected children had pharyngeal swabs repeated two to five days after completing a 10-day course of penicillin V. M and T typing, and pulsed field gel electrophoresis were performed on the isolates, and the isolates were evaluated for tolerance. Patient characteristics and clinical features were noted and nasopharyngeal swabs for respiratory viruses were taken at enrolment. Of 286 patients enrolled, 248 (87%) could be evaluated. GABHS was cultured from 104 patients (41.9%), of whom 33 (33.7%) had microbiological treatment failures on follow-up. Although there was a trend toward failure for younger children (mean 6.5+/-2.4 years versus 7.3+/-2.4 years, P=0.07) and M type 12 (24% versus 10%, P=0.08), no factors were associated with treatment failure.

Benefit of Adhering to Antiretroviral Therapy Confirmed

Anyone who has tried to adhere completely to a 10-day course of penicillin for streptococcal pharyngitis can imagine how much more demanding long-term

Poststreptococcal Reactive Arthritis in Adults: A Case Series

Objective To guide primary care physicians regarding the diagnosis and treatment of poststreptococcal reactive arthritis (PSReA) in adults. Patients and Methods We retrospectively reviewed an indexed database of all patients evaluated or hospitalized between 1976 and 1998 at Mayo Clinic Rochester and identified 35 patients with the diagnosis of reactive streptococcal arthritis, arthralgia, or arthritides. Twenty-nine patients with the diagnosis of acute rheumatic fever (ARF), septic streptococcal arthritis, or nonspecific reactive arthritis were excluded. Results PSReA was confirmed in 6 adults (3 women, 3 men; age range, 25–66 years). All patients were symptomatic with polyarthritis and oligoarthritis disproportionate to the objective findings on physical examination. Although all patients had negative throat cultures at the onset of arthritis, increased titers of anti-DNase B and antistreptolysin O confirmed recent streptococcal infection. Antecedent events included pharyngitis in 3 patients (who had received a minimum of a 10-day course of penicillin) and toxic shock syndrome in 1 patient. The latency of onset of arthritis ranged from 4 days to 6 weeks. The arthritic symptoms had a protracted course beyond the typical maximum of 3 weeks described for ARF. Treatment with aspirin did not provide symptomatic relief in any of the patients, whereas the response to therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) was at least partial in all cases. Symptomatic relief occurred in 1 patient who received indomethacin and in 1 patient treated with prednisone. Penicillin prophylaxis was recommended in 1 patient. Conclusion PSReA should be included in the differential diagnosis of all adult patients presenting with arthritis. Treatment strategies include aspirin, other NSAIDs, and corticosteroids. In adult patients with PSReA, there is no evidence to support the use of penicillin prophylaxis at this time. To guide primary care physicians regarding the diagnosis and treatment of poststreptococcal reactive arthritis (PSReA) in adults. We retrospectively reviewed an indexed database of all patients evaluated or hospitalized between 1976 and 1998 at Mayo Clinic Rochester and identified 35 patients with the diagnosis of reactive streptococcal arthritis, arthralgia, or arthritides. Twenty-nine patients with the diagnosis of acute rheumatic fever (ARF), septic streptococcal arthritis, or nonspecific reactive arthritis were excluded. PSReA was confirmed in 6 adults (3 women, 3 men; age range, 25–66 years). All patients were symptomatic with polyarthritis and oligoarthritis disproportionate to the objective findings on physical examination. Although all patients had negative throat cultures at the onset of arthritis, increased titers of anti-DNase B and antistreptolysin O confirmed recent streptococcal infection. Antecedent events included pharyngitis in 3 patients (who had received a minimum of a 10-day course of penicillin) and toxic shock syndrome in 1 patient. The latency of onset of arthritis ranged from 4 days to 6 weeks. The arthritic symptoms had a protracted course beyond the typical maximum of 3 weeks described for ARF. Treatment with aspirin did not provide symptomatic relief in any of the patients, whereas the response to therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) was at least partial in all cases. Symptomatic relief occurred in 1 patient who received indomethacin and in 1 patient treated with prednisone. Penicillin prophylaxis was recommended in 1 patient. PSReA should be included in the differential diagnosis of all adult patients presenting with arthritis. Treatment strategies include aspirin, other NSAIDs, and corticosteroids. In adult patients with PSReA, there is no evidence to support the use of penicillin prophylaxis at this time.

Poststreptococcal Reactive Arthritis in Adults: A Case Series

To guide primary care physicians regarding the diagnosis and treatment of poststreptococcal reactive arthritis (PSReA) in adults. We retrospectively reviewed an indexed database of all patients evaluated or hospitalized between 1976 and 1998 at Mayo Clinic Rochester and identified 35 patients with the diagnosis of reactive streptococcal arthritis, arthralgia, or arthritides. Twenty-nine patients with the diagnosis of acute rheumatic fever (ARF), septic streptococcal arthritis, or nonspecific reactive arthritis were excluded. PSReA was confirmed in 6 adults (3 women, 3 men; age range, 25-66 years). All patients were symptomatic with polyarthritis and oligoarthritis disproportionate to the objective findings on physical examination. Although all patients had negative throat cultures at the onset of arthritis, increased titers of anti-DNase B and antistreptolysin O confirmed recent streptococcal infection. Antecedent events included pharyngitis in 3 patients (who had received a minimum of a 10-day course of penicillin) and toxic shock syndrome in 1 patient. The latency of onset of arthritis ranged from 4 days to 6 weeks. The arthritic symptoms had a protracted course beyond the typical maximum of 3 weeks described for ARF. Treatment with aspirin did not provide symptomatic relief in any of the patients, whereas the response to therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) was at least partial in all cases. Symptomatic relief occurred in 1 patient who received indomethacin and in 1 patient treated with prednisone. Penicillin prophylaxis was recommended in 1 patient. PSReA should be included in the differential diagnosis of all adult patients presenting with arthritis. Treatment strategies include aspirin, other NSAIDs, and corticosteroids. In adult patients with PSReA, there is no evidence to support the use of penicillin prophylaxis at this time.

Group A streptococcal carriage: Can the troll be tamed?

The dilemma of determining optimal care for the child with repeatedly positive throat cultures for group A beta hemolytic streptococcus (group A strep) has bedevilled paediatricians, family practitioners and generalists for decades. Unfortunately, the state of the art has not changed substantially over the past 20 years, as attested to by the dearth of publications and the similarity of the definitive recommendations spanning that period (1,2). The purpose of this column is to review briefly the state of knowledge about chronic streptococcal carriage and to suggest a rational approach to treating children who present with this problem. The challenge of evaluating a child with a positive throat culture for group A strep results from the inability to distinguish between the carrier (one who harbours the organism without a host response) and the child who is acutely infected (one who has evidence of inflammation and host response). Carriers are often identified when they continue to harbour the organism in the throat asymptomatically after an appropriate 10-day course of penicillin or alternative agent (3). There is a high rate of carriage in the general population (approximately 5% to 15% of school-aged children are colonized but not infected with group A strep at any time), and there is no foolproof way to differentiate a priori between carriers and those who are acutely infected. Therefore, many children are diagnosed with streptococcal pharyngitis who are chronic carriers and who are probably acutely infected with another organism (such as a respiratory virus). In this era of evolving antibiotic resistance and a desire to limit unnecessary use of antimicrobial agents, a logical strategy for avoiding therapy of chronic carriers is required. Chronic carriers of group A strep probably do not pose a threat to themselves or to others. There is no evidence that these children or their contacts become infected with the strains that these children carry. Therefore, they do not require antibiotic therapy to prevent suppurative or nonsuppurative (acute rheumatic fever, acute poststreptococcal glomerulonephritis) complications. So why do doctors need to worry? The simple answer is that physicians are unable to differentiate at presentation between the child who is acutely infected and the one who is a chronic carrier presenting with acute nonstreptococcal pharyngitis. The methods for making that discrimination (testing for serological response and strain typing) require time and the aid of reference or research laboratories. What can the medical practitioner do when confronted with a child who repeatedly returns to the office or clinic for evaluation of or therapy for acute respiratory illnesses in which group A strep is recovered from the throat? If it could be determined a priori whether that child is a streptococcal carrier, antibiotic therapy could be avoided. A child is likely a carrier if he or she has symptoms most consistent with a viral upper respiratory infection and has consistently harboured group A strep in the past. However, the discriminatory power of clinical evaluation of such patients is notoriously unreliable. Perhaps the most expedient strategy is to attempt eradication of the carrier state. If successful, ie, the child has a negative culture after completion of therapy, one might assume that if the child presents again with pharyngitis and a throat culture positive for group A strep, this is evidence of bone fide acute streptococcal infection. Eradication of carriage should probably be reserved for children who remain culture-positive after a full and appropriate course of antibiotic therapy, and who have had at least three symptomatic episodes of pharyngitis with

Efficacy of 5-day cefpodoxime proxetil for recurrent pharyngitis in adults. A comparative study with 10-day penicillin V or amoxycillin—clavulanate

OBJECTIVE: To compare the clinical and bacteriologic efficacy of a 5-day course of cefpodoxime proxetil (CPD) with that of a 10-day course of penicillin V (PNV) or amoxycillin---clavulanate (AMC) in recurrent pharyngitis in adults. A cost-effectiveness study (reported elsewhere) was carried out at the same time. METHODS: This multicenter, randomized, open label trial involved 580 adult patients consulting general practitioners for clinical recurrent pharyngitis (greater-than-or-equal3 episodes within the last 12 months) regardless of the bacterial etiology. Patients were treated for 5 days with CPD, 100 mg twice daily, or for 10 days with PNV, 1x106 IU three times a day, or for 10 days with AMC, 500 mg (amoxycillin) three times a day. Clinical and bacteriologic outcomes were noted at the end of treatment, and cases of clinical recurrence were recorded during a 6-month follow-up period. RESULTS: At the end of treatment, clinical response was satisfactory in 157 of 170 (92.3%) patients on CPD, 147 of 166 (88.5%) patients on PNV, and 168 of 177 (94.9%) patients on AMC. Group A beta-hemolytic streptococci (GABHS) were eradicated in 22 of 23 (95.65%) patients on CPD, 16 of 16 (100%) patients on PNV, and 19 of 20 (95%) patients on AMC. The rates of clinical success and GABHS eradication were not significantly different between the groups. Compliance (p<0.001) and tolerance (p<0.001) were significantly better in the CPD group than in the other two groups. Among the 389 patients evaluable 6 months after the end of treatment, the recurrence rate of acute pharyngitis (due to any bacterium) was significantly lower in the CPD group (p=0.01 versus PNV; p<0.01 versus AMC). A Kaplan---Meier analysis (469 patients over 6 months) of the rate of non-recurrence, with comparison by the log-rank test, also showed a significant difference in favor of CPD. CONCLUSIONS: A 5-day treatment of recurrent pharyngitis with CPD was as effective and better tolerated than a 10-day treatment with PNV or AMC. The risk of recurrence was lower with CPD.

Office diagnosis and management of group A streptococcal pharyngitis employing the rapid antigen detecting test. A 1-year prospective study of reliability and cost in primary care centres

The impact of introducing the rapid antigen detecting test for the diagnosis of group A streptococcal pharyngitis in primary care centres and the direct and comprehensive cost-effectiveness of four alternative strategies for the management of group A streptococcal pharyngitis and the prevention of rheumatic fever were assessed in a 1-year prospective randomized study, carried out in children between the ages of 5 and 14 years. Data from the study showed that the test was easy to perform and reliable when introduced as a service in primary care. The strategy of using the rapid antigen detecting test and a 10-day oral penicillin course for diagnosis and treatment proved to be the safest and most cost-effective. If compliance with a 10-day course of oral penicillin is unlikely to be achieved, the strategy of introducing the test and treatment by intramuscular benzathin penicillin G proved to be the second best cost-effective alternative. In developing countries, where acute rheumatic fever is still common and the cost of the test and a 10-day course of penicillin may prove to be formidable, a strategy of treating all children with pharyngitis with intramuscular benzathin penicillin G seems to be the most cost-effective. The strategy of diagnosing group A streptococcal pharyngitis on clinical grounds proved to be the worst.

Lack of impact of early antibiotic therapy for streptococcal pharyngitis on recurrence rates

To determine whether recurrence rates for group A beta-hemolytic streptococcal (GABHS) pharyngitis are related to the time of initiation of antibiotic therapy, we randomly assigned 113 patients with GABHS pharyngitis either to a group that began a 10-day course of penicillin V at the time of diagnosis or to a group that began the same antibiotic regimen after a dealy of 48 hours. Follow-up throat culture specimens were obtained 4 days, 2 months, and 4 months after the completion of antibiotic therapy, as well as during any interim episodes of acute pharyngitis. Serotyping of all GABHS isolates was performed to distinguish between recurrences with homologous serotypes and new acquisitions with heterologous serotypes. There was no significant difference between the two treatment groups in age, gender, duration of illness before enrollment in the study, initial clinical presentation, or compliance. Of the 50 patients in the immediate-treatment group, 6 (12%) had homologous serotypes of GABHS isolated on one of the follow-up throat cultures. Of the 63 patients in the delayed-treatment group, 9 (14%) had homologous serotypes of GABHS isolated on one of the follow-up throat cultures. These data indicate that a 48-hour delay in the initiation of penicillin therapy for GABHS pharyngitis does not reduce the recurrence rate.

Incidence of acute rheumatic fever. A suburban community hospital experience during the 1970s.

The incidence of acute rheumatic fever has declined remarkably in the past three decades, but the disease has not been eradicated, as some physicians believe. This study documents the diagnosis of the disease in 23 middle-class children from Fairfax County, Virginia, during the 11-year-period from 1970 through 1980. This county has one of the highest median family incomes in the United States. The annual age-adjusted incidence rate of initial attacks of acute rheumatic fever per 100,000 Fairfax County children declined from 3.0 in 1970 to 0.5 in 1980. In six of the 23 children, carditis accompanied by monarticular arthritis or arthralgia was present. Another seven children had carditis plus polyarthritis. Two patients had Sydenham's chorea. None of the children had erythema marginatum or rheumatoid nodules. In two children, symptoms of acute rheumatic fever developed two weeks after they finished a 10-day course of penicillin for Group A streptococcal pharyngitis. The remaining 21 children had not been considered ill enough to be brought to medical care prior to development of symptoms of acute rheumatic fever.