Penicillin Preparations Research Articles

Virtual exhibitions for scientific knowledge propagation

Scientific knowledge propagation is among the key functions of the Common Scientific Knowledge Digital Space (CSKDS), and the virtual exhibitions (VE) as an efficient instrument enable to accumulate heterogeneous scientific information on phenomena, events or scholars. The authors discuss the general issues and principles of VE organization, content selection, VE structure and main sections. Three VE types are specified, namely autonomous, remote and combined VE. Selection and content structuration methods are proposed for each of the types. The authors introduce extensibility and flexibility as VE characteristics. They also describe in detail the VE experience of the RAS Interdepartmental Supercomputer Center as a model CSKDS element. They describe the VE “Mrs. Penicillin” dedicated to Zinaida Vissarionovna Ermolyeva, a microbiologist who created the preparation of penicillin in the USSR in the late 1930s. The exhibition offers information about Ermolyeva, her scientific and pedagogical work.The study is accomplished at Russian Academy of Sciences Interdepartmental Supercomputer Center, branch of RAS Research Institute of System Analysis within the framework of the Government Order No. FNEF-2024-0014.

A case of early syphilitic hepatitis that was rapidly cured by a single intramuscular injection of a continuous penicillin preparation

症例は50歳代男性．全身倦怠感，皮膚掻痒感，褐色尿を主訴に受診し血液検査で総ビリルビンや肝胆道系酵素の上昇を認めた．肝炎ウイルスマーカーや自己抗体は陰性であった．第5病日に入院時はみられていなかった皮疹が四肢体幹に出現し，入院時の梅毒反応定性が陽性であったため，再度詳細に病歴を聴取したところ，入院2カ月前の性風俗産業利用歴が判明した．早期梅毒第2期及び早期梅毒性肝炎と診断したが，患者が近日中に転居予定で長期入院や頻回な外来通院は困難であったことから，2022年1月から本邦で使用可能となった早期梅毒には単回投与での治療が認められているベンジルペニシリンベンザチン水和物（BPB）筋注を用いた．皮疹や肝障害は速やかに改善し，梅毒は治癒した．本邦において早期梅毒性肝炎の治療にBPB筋注が用いられた報告はみられず，有効な治療法と考えられたため，文献学的考察を加えて報告する．

Akutni tonzilitis i akutni faringitis

Acute tonsillitis and pharyngitis are common diseases in clinical practice. Uncritical use of antibiotics has led to an increasing problem of antibiotic resistance. On the other hand, it is of great importance to correctly diagnose and timely treat bacterial tonsillopharyngitis in order to prevent complications. The aim of this paper was to review current guides and published papers in the professional literature related to diagnostics and therapy in children and adults, with the aim of their greater implementation in clinical practice. Acute tonsillopharyngitis is far more often - a viral infection, less often - a bacterial infection. In the differential diagnosis of these entities, the combination of clinical scores and rapid test for group A streptococcus is of the greatest importance. According to individual clinical assessment, microbiological analysis of throat swabs and laboratory blood tests may also be important. Viral tonsillopharyngitis is treated symptomatically. In the treatment of bacterial infections, penicillin preparations are the drug of choice. Treatment can be combined with a single dose of orally administered corticosteroid. The basic principle of treatment of acute tonsillopharyngitis must be a measure of clinical parameters, available diagnostics, general condition of the patient and his comorbidities.

История жизни и научной деятельности советского микробиолога З. В. Ермольевой в документах российских федеральных архивов

The article analyzes unpublished sources stored in the Russian State Archive of Economics (RGAE), the State Archive of the Russian Federation (GARF), and the Russian State Archive in Samara (RGA v Samare) to determine the representativeness of these documents in reconstruction of the scientific biography of the Soviet microbiologist Zinaida Vissarionovna Ermolieva (1898-1974). The coronavirus pandemic, which has engulfed all the humanity, has changed the vector of biomedical research subjects. In this regard, one of the important tasks of humanitarian researchers is to update historical knowledge about extreme periods. The task of studying the life and work of Soviet scientists who made a significant contribution to studying epidemic diseases and fighting them seems significant. Scarсity of publications devoted to the activities of Z. V. Ermolyeva means that an extensive layer of unpublished documents remains out of view of researchers. Source analysis, archival heuristics, and historical-comparative method permit to conduct research and to assess the informative value of different types of documents for comprehensive reconstruction of Z. V. Ermolyeva’s scientific fate. In the RGAE, a great number of documents is concentrated in the scientist’s personal fond, its analysis shows that official, scientific, and personal documents are stored there. In addition to text documents, there are photos of Zinaida Vissarionovna with her colleagues in various scientific institutions which are of great interest. Some official documents also provide personal information. In the GARF, documents on this topic are dispersed in different fonds. The fond of the All-Union Institute of Experimental Medicine, where Z. V. Ermolyeva worked, contains information on preparation of first Soviet penicillin and launch of its production. The fond of the People's Commissariat of Health of the USSR permits to follow the discussion of her scientific works at its Scientific Medical Council meetings. The documents of the Committee for the Assistance of Scientists under the Council of People's Commissars of the USSR help to reconstruct elements of material support provided to Ermolyeva in the 1930s. Among the sources stored in the RGA in Samara, of interest are application documents for inventions, in which Zinaida Vissarionovna participated. They show the scientist as the author of inventions and scientific discoveries. The analysis demonstrates that conjunctive use of documents from federal archives showcase multifaceted activities of the well-known microbiologist.

Why Was There Ever a Warning Not to Use Cephalosporins in the Setting of a Penicillin “Allergy”?

It is now well-established that avoiding β-lactam antibiotics, when they are the drugs of choice, results in significantly worse long-term global outcomes for patients. Much of this avoidable morbidity has been caused by widespread warnings in electronic health care record systems not to use cephalosporins in the setting of penicillin allergy. High rates, up to 1000-fold higher than now seen, of immunologically mediated reactions were associated with early impure penicillin preparations. This instilled a rational fear of β-lactam-associated anaphylaxis in generations of physicians. In the late 1970s, several editorial comments regarding a potential increased risk to patients given cephalosporins who had a history of a penicillin allergy resulted in the warning that became imbedded in the culture of medicine. Over the past 40 years, compelling data have been developed that refute this warning and showed that the risks of avoiding cephalosporins outweighed the benefits. In late 2017, Kaiser Permanente Southern California completely removed all warnings not to use cephalosporins in the setting of a penicillinallergy. The results have recently been published in JAMA Network Open. This Rostrum article provides some of thebackstory on the establishment and removal of this warningforphysicians who trained over the past 30 years.

Microbiological aspects of pulmonary infection with Actinomyces odontolyticus - case report

Pulmonary actinomycosis is a rare and uncommon invasive bacterial disease. We are presenting a case report of 45 year old male patient with severe acute pneumonia with pleural effusion, presenting with fever, fatigue, productive cough, chest pain, dyspnea and swelling on both legs. Microbiological findings showed an isolation of anaerobic bacterium Actinomyces odontolyticus. The antibiogram showed sensitivity on penicillin and penicillin preparations, cephalosporins and carbapenems. There was an intermediate sensitivity on quinolones and there was a resistance on lincosamins and aminoglycosides. Our patient was treated with operation and received appropriate antibiotic therapy, after which there was a very good improvement, both clinically and on control native lung RTGs. This disease has excellent prognosis with early detection and proper treatment. Penicillin is the drug of choice for treatment of pulmonary actinomycosis.

Efficiency of combined action of antimicrobial preparations against poly-resistant strains of conditionally-pathogenic bacteria isolated from wounds of surgery patients

The strategy of use of combination therapy of antibacterial preparations is being broadly introduced to clinical practice to fight bacterial infections caused by poly-resistant strains of microorganisms. From the wounds of surgery patients, we isolated 67 clinical strains of conditionally-pathogenic bacteria identified as Staphylococcus aureus, S. epidermidis, Escherichia coli, Klebsiella pneumoniaе, Proteus vulgaris, Proteus mirabilis, Pseudomonas aeruginosa. Using disk diffusion method, the isolated bacterial strains were found to be most resistant to penicillin preparations: ampicillin, oxacillin, amoxicillin/clavulanat; tetracycline and cephalosporin of the II generation – cefoxitin. The percentage of strains insusceptible to these antibacterial preparations accounted for 65.0%. The division of antibiotic-resistant cultures regarding phenotype groups according to the level of their antibiotic resistance allowed determination of 4 PDR-, 8 XDR- and 14 MDR-strains. During the studies on experimental determining of MIC of antibiotic and antiseptics in the condition of applying them as monopreparations against isolated bacterial cultures, we saw significant exceess in the threshold values of MIC, and, first of all, regarding pandrug-resistant and extensive drug-resistant clinical microbial isolates. Use of combinations of antibacterial preparations was found to show the synergic effect of antibiotics (ceftriaxone, ofloxacin, gentamicin) and antiseptics (chlorhexidine, decasan), which is expressed in simultaneous decrease in MIC of each of the tested preparations by 2–8 times compared with their isolative application. Such combinatory approach regarding simultaneous application of antibacterial preparations may be considered as one of the most promising ways to combat poly-resistant clinical isolates of conditionally-pathogenic microorganisms and to offer a new strategic approach to prevention of spread of antibiotic resistance as a phenomenon in medical practice.

Historical and Hygienic Aspects on Roles of Quality Requirements for Antibiotic Products in Japan : Part 3-Introduction of Technology and Knowledge in the Production Process and Quality Control of Penicillin from the United States of America.

In order to investigate the roles of quality requirements for antibiotic products in Japan, from historical and hygienic aspects, we examined and analyzed how technology and knowledge in the production and quality control of penicillin were introduced from the United States of America, applied, and further developed. Owing to the strong support of Colonel Crawford Sams, the chief of the Public Health and Welfare Section of the Supreme Commander for Allied Power/General Headquarters, via the Ministry of Welfare in Japan, the technology and knowledge were acquired from an experienced leader, Dr. Jackson W. Foster, and as a result, domestic production of penicillin was successfully achieved in amounts required to meet national demands sufficiently within three years in a devastated post-war-torn Japan. Based on the consensus that penicillin should be dealt with as “biological products” similar to vaccines and antisera, the quality standards for penicillin were enacted as the “Minimum Requirements for Penicillin (MRP)” on the 1st of May 1947. Due to the development of penicillin production technology, the quality standards of penicillin provided by the MRP were revised often to higher levels ; content of the active element from no less than 60 units/mg (purity 3.8%) to no less than 1,430 units/mg (purity 89.7%). Regarding the penicillin preparations, the content of the active ingredient per vial was changed from 30,000 units at the beginning, to 100,000 units in January 1948, to 3,000,000 units in December 1950, and two preparations containing 200,000 units and 1,000,000 units per vial are currently available, according to clinical convenience.

Subcutaneous administration of benzathine benzylpenicillin G has favourable pharmacokinetic characteristics for the prevention of rheumatic heart disease compared with intramuscular injection: a randomized, crossover, population pharmacokinetic study in healthy adult volunteers.

Benzathine penicillin G has been used as monthly deep intramuscular (IM) injections since the 1950s for secondary prevention of acute rheumatic fever and rheumatic heart disease (RHD). Injection frequency and pain are major programmatic barriers for adherence, prompting calls for development of better long-acting penicillin preparations to prevent RHD. We hypothesized that subcutaneous (SC) administration of benzathine penicillin G could delay penicillin absorption when compared with IM injections. To compare the pharmacokinetic profile and tolerability of benzathine penicillin G according to different routes of administration, 15 healthy males participated in a randomized crossover study to receive benzathine penicillin G by either SC or IM routes, with a 10 week washout period before the second dose by the alternative route. Ultrasound guidance confirmed injection location. Penicillin concentrations and pain scores were measured for 6 weeks following injections. SC administration was well tolerated with no significant differences in pain scores. Following SC injection, the principal absorption half-life (95% CI) was 20.1 (16.3-29.5) days and 89.6% (87.1%-92.0%) of the drug was directed via this pathway compared with 10.2 (8.6-12.5) days and 71.3% (64.9%-77.4%) following IM administration. Lower peak and higher trough penicillin concentrations resulted following SC injection. Simulations demonstrated that SC infusion of higher doses of benzathine penicillin G could provide therapeutic penicillin concentrations for 3 months. SC administration of benzathine penicillin G is safe and significantly delays penicillin absorption. High-dose benzathine penicillin G via the SC route would fulfil many product characteristics required for the next generation of longer-acting penicillins for use in RHD.

Lues Maligna in an Immune-Reconstituted Patient with Retroviral Infection: A Case Report

Lues Maligna in an Immune-Reconstituted Patient with Retroviral Infection: A Case Report

Evaluation of the role of oral penicillin for treating Lyme disease patients with erythema migrans in the United States

Clinical trials of oral penicillin preparations in the United States for treating Lyme disease patients with erythema migrans are limited to 2 studies. The results of these studies demonstrated a less than optimal outcome of this treatment. However, there were serious methodologic concerns in both studies precluding the interpretation that phenoxymethylpenicillin specifically should be regarded as ineffective. Therefore, additional clinical trials should be conducted in the United States with close attention to the dose and duration of treatment that have been used very successfully in Europe.

RATIONAL ANTIBACTERIAL THERAPY FOR TOXIC OSTEONECROSIS OF THE JAWS

The purpose of our study was to determine the species composition of microflora and to study its sensitivity to antibiotics for toxic osteonecrosis of the jaws, depending on the phase of the inflammatory process to develop the principles of rational antibacterial therapy of this pathology.
 The Methods. A retrospective study of 38 patients aged from 21 to 45 years old, observed in the dental clinic of PSMU from 2012 to 2018, including 25 men and 13 women, was conducted. They were divided into 2 groups. The first group (19 people) were admitted for emergency treatment in the acute phase of the inflammatory process, accompanied by the development of pyo-inflammatory complications in the maxillofacial area. The second group (19 people) were hospitalized as planned for sequestrectomy. Bacteriological research from a pathological focus was carried out with all of the subjects, followed by determination of the sensitivity of the selected microflora to antibiotics.
 The rezults. After analyzing the results, it turned out that differences in the composition of the predominant microflora were revealed in the different study groups: in the group of patients with osteonecrosis in the acute phase, the prevailing group of bacteria were staphylococci, in the group of patients with osteonecrosis in the chronic phase - streptococci. In addition, in the first group, the presence of such microorganisms as enterococci and acinetobacter was noted, and in the second group, bacilli and fungi. Also, the isolated microorganisms in the first group were more susceptible to antibiotics than in the second. At the same time, it is preferable to use levofloxacin and gentamicin in both study groups. In addition, penicillin preparations, cephalosporins and chloramphenicol can be used in the acute phase.
 Summary. This study showed that the composition of microflora in toxic osteonecrosis is diverse and depends on the phase of the inflammatory process. It is the basis for the appointment of a rational antibacterial therapy, which contributes to more successful treatment of this disease, reducing the risk of developing severe purulent complications and generalizing the inflammatory process.

Role of antibiotic therapy in the treatment of streptococcal infection

The article states the principles for antibiotic therapy for chronic tonsillitis (CT) and acute tonsillopharyngitis (ATP). The greatest attention is paid to the non-angina CT, when the patients, as a general rule, are deprived of antibiotic therapy. At the same time, the article provides data of St. Petersburg Research Institute of ENT, whereby at least 40% of patients with CT have streptococcal etiology of the disease caused by group A beta-hemolytic streptococci (GABHS) that is confirmed by not only bacteriological, but also immunological research methods (increase in antistreptolysin-O). In addition, the number of diseases caused by groups C and G beta-hemolytic streptococci has increased in recent years. These groups of streptococci contribute to the development of complications like those caused by GABHS, and therefore the doctor’s attitude towards them should be more critical and in some respects - the same as to GABHS. As you know, streptococcal infection is one of the most dangerous due to the development of internal organs and systems complications. This proposition justifies the need for systemic antibacterial therapy in patients with CT, when they are diagnosed with streptococcal infection, regardless of the presence of angina. In vitro studies showed that GABHS has good sensitivity to penicillin preparations. However, it is not always possible to achieve treatment targets in practice. Given that the duration of antibiotic therapy for streptococcal infection should be at least 10 days, it is difficult to achieve full medication adherence. In this regard, prolonged-release penicillins, such as Bicillin-5, gain ground. The article substantiates the use of this drug in CT, discusses a clinical case, which shows the medical history of a girl with coexistent affection with GABHS of the pharynx and vagina. Only 4-month administration of Bicillin-5 allowed to cure the patient, having achieved GABH eradication.

Elimination of Mother-to-child Transmission of Syphilis: Challenge and Solution

Abstract Congenital syphilis (CS) is a significant public health problem worldwide. The majority of cases of CS are caused by in utero transmission. The World Health Organization launched the global elimination of CS initiative with the goal of reducing mother-to-child transmission of syphilis. The risk for CS is mainly related to three factors: (1) high maternal prevalence, (2) low coverage of antenatal care services, and (3) treatment failure. The long-acting penicillin preparations such as benzathine penicillin G are the preferred therapies for maternal syphilis. There are several challenges in preventing CS from both pregnant women and their health care providers. These problems include that prenatal care lack or delay, syphilis management flaws from health care providers, lacks of basic information, and awareness about maternal syphilis and CS by public. Many efforts have been made to solve the problems. These include that dual elimination of mother-to-child transmission (EMTCT) of both human immunodeficiency virus (HIV) and syphilis or triple EMTCT of HIV, syphilis and hepatitis B, World Health Organization country validation of EMTCT of syphilis and HIV, set up a CS case review board and a National Day to combat syphilis and CS.

Preparation and detailed structural characterization of Penicillin G imprinted polymers by PALS and XPS

Template molecule selected in this study, namely penicillin G (PG) is a member of β-lactam antibiotics (BLAs) and the first antibiotic found by human and used to treat bacterial diseases. PG imprinted polymers were prepared by grafting onto PE/PP non-woven fabrics via gamma irradiation. Methacrylic acid (MAA) and ethylene glycol dimethylacrylate (EGDMA) were used as functional monomer and crosslinking agent, respectively. Non-imprinted polymers (NIP) were also synthesized using the same procedure in the absence of PG. Chemical and physical characterizations of fabrics grafted with molecularly imprinted polymers (MIP) were carried out by using FTIR-ATR, XPS, SEM and positron annihilation lifetime spectroscopy (PALS). Binding behaviour of MIP was investigated for various template concentrations. Uptake and release of template molecule were determined by HPLC. Imprinting factor IF (IF = ratio of binding to MIP/binding to NIP) was determined as 4.46 for 1.0 ppm PG solution for a 3-h incubation.

Mastitis in mare: case report

Mastitis is rare in mares compared with cattle, a mare suffered from mastitis was referred to the Veterinary Teaching Hospital, College of Veterinary Medicine, University of Mosul for examination with a history of abortion before two months and gradually loss of body weight. Clinical examination revealed, a swollen left mammary gland, painful to palpate, there was mild degree of edema in the tissue surrounding the gland, fluid with clot expressed from the gland, body temperature was 37.4ºC and heart rate was 40/ minute. Fluid (mammary secretions), milk samples were collected under sterile condition and submitted to the laboratory for bacterial culture and identification test. The results of the culture and biochemical tests showed that the Staphylococcus spp was the etiological agent. This case was treated with systemic and local antibiotic therapy (Penicillin preparation).

Penicillin Dried Blood Spot Assay for Use in Patients Receiving Intramuscular Benzathine Penicillin G and Other Penicillin Preparations To Prevent Rheumatic Fever.

Rheumatic heart disease (RHD) remains an important global health challenge. Administration of benzathine penicillin (BPG) every 3 to 4 weeks is recommended as a secondary prophylaxis to prevent recurrent episodes of acute rheumatic fever and subsequent RHD. Following intramuscular injection, BPG is hydrolyzed to penicillin G (benzylpenicillin). However, little is known of the pharmacokinetics (PK) of BPG in pediatric populations at high risk of RHD or of the pharmacokinetic-pharmacodynamic relationship between penicillin exposure and clinically relevant outcomes. Dried blood spot (DBS) assays can facilitate PK studies in situations where frequent venous blood sampling is logistically difficult. A liquid chromatography-mass spectroscopy assay for penicillin G in plasma and DBS was developed and validated. Application of the DBS assay for PK studies was confirmed using samples from adult patients receiving penicillin as part of an infection management plan. The limit of quantification for penicillin G in DBS was 0.005 mg/liter. Penicillin G is stable in DBS for approximately 12 h at room temperature (22°C), 6 days at 4°C, and >1 month at -20°C. Plasma and DBS penicillin G concentrations for patients receiving BPG and penicillin G given via bolus doses correlated well and had comparable time-concentration profiles. There was poor correlation for patients receiving penicillin via continuous infusions, perhaps as a result of the presence of residual penicillin in the peripherally inserted central catheter, from which the plasma samples were collected. The present DBS penicillin G assay can be used as a surrogate for plasma concentrations to provide valid PK data for studies of BPG and other penicillin preparations developed to prevent rheumatic fever and RHD.

<italic>In vivo</italic> imaging of penicillin G acylase in mice via a near-infrared fluorescent probe

Penicillin G acylase (PGA) is a hydrolytic enzyme, which is also industrially employed in the preparation of semisynthetic penicillin. Abuse of PGA might occur in milk products to decompose the possible excessive antibiotics. Detection of PGA, including in vivo imaging of PGA, is necessary to understand the potential function of this enzyme in living biosystems; however, a near-infrared (NIR) fluorescent probe for PGA is still lacking. On the basis of amino hemicyanine as well as the ability of PGA to hydrolyze phenylacetamide, in this work we have developed a new selective and sensitive NIR fluorescent probe for such a purpose. Combined with in vivo fluorescence imaging system, the probe has been preliminarily used to image the change of the PGA activity in mice. In addition, the NIR feature of our probe makes it of potential use in studying the function of PGA in vivo .

ФАРМАКОЕПІДЕМІОЛОГІЧНИЙ АНАЛІЗ ТЕНДЕНЦІЙ ВИКОРИСТАННЯ БЕТА-ЛАКТАМНИХ АНТИБІОТИКІВ ДЛЯ ЛІКУВАННЯ ПНЕВМОНІЇ В РЕСПУБЛІЦІ ТАДЖИКИСТАН

Мета роботи. Провести ретроспективний аналіз споживання р-лактамних антибіотиків для лікування позалікарняної пневмонії в стаціонарах Республіки Таджикистан з використанням DDD-методолопї.Матеріали і методи. Оцінювали споживання р-лактамних антибіотиків згідно з індексом ATC/DDD ВООЗ за 2011-2015 рр. В якості одиниці вимірювання використовувалося кількість грамів активної речовини з подальшим розрахунком показника загальної DDDs, DDDs/100 ліжко-днів та % від загальної DDDs.Результати й обговорення. Проведено ретроспективний аналіз споживання р-лактамних антибіотиків для лікування позалікарняної пневмонії в пульмонологічному відділенні багатопрофільного стаціонару Республіки Таджикистан. Встановлено збільшення споживання р-лактамних антибіотиків для лікування пневмонії за 2011­2015 рр. Виявлена динаміка зумовлена виключно за рахунок збільшення споживання антибактеріальних препаратів з групи цефалоспоринів, а саме цефалоспорину III покоління - цефтриаксону. При цьому знизився інтерес в якості антибактеріальних препаратів для лікування позалікарняної пневмонії до антимікробних препаратів з групи пеніцилінів.Висновки. Спостерігається поступове скорочення застосування для фармакотерапії позалікарняної пневмонії застарілих малоефективних препаратів пеніцилінового ряду (ампіцилін) і невиправдане зниження призначення одного з найбільш ефективних і безпечних антибіотиків - амоксициліну. Позитивним є також зниження призначення цефалоспоринів першого покоління (цефазоліну). При цьому велика популярність цефтриаксона становить потенційну небезпеку зростання резистентності до цього препарату і розвитку побічних реакцій, що вимагає більш ретельного контролю раціональності застосування даного антибіотика.

P.2.001 - Serotonergic modulation of cognition; a dissociate effect of escitalopram on distinct cognitive mechanisms

Infections due to Streptococcus pyogenes and their complications are a problem of major concern in many countries, including India. Primary prophylaxis with benzathine penicillin is the key to control and prevent sequelae such as acute rheumatic fever and rheumatic heart disease (RF/RHD) or post-streptococcal glomerulonephritis (PSGN). Non-compliance to prophylaxis due to fear of injection and anaphylaxis is major issues in RF/RHD control in India and leads to continued high prevalence of infection and post-streptococcal sequelae. Differing reports on the efficacy of two weekly, three weekly or monthly injections raise questions on the actual dosages to be administered. Availability of more effective antibiotics with better dosages has replaced the use of penicillin; hence, companies are reluctant to manufacture penicillin preparations in India. It is in this context that a concept of a Group A streptococci vaccine is looked at and whether or not a globally designed vaccine will be useful in the Indian context. Modern molecular techniques and genomic analysis of S. pyogenes have identified many molecules as vaccine candidates among which the M-protein has attracted the most attention. High diversity of M (emm) types in endemic regions raises questions about the efficacy of such a vaccine. A recent 30-valent M-protein-based vaccine that elicits antibodies to homologous as well as non-vaccine M types looks promising. This review will discuss the genomics of S. pyogenes, the various candidate vaccine molecules and highlight their efficacy in the Indian context where control of post-streptococcal sequelae remains a challenge.