Penicillin tolerance and treatment failure in group A streptococcal pharyngotonsillitis
- 1 February 1996
- journal article
- review article
- Published by Springer Science and Business Media LLC in European Journal of Clinical Microbiology & Infectious Diseases
- Vol. 15 (2), 107-115
- https://doi.org/10.1007/bf01591482
Abstract
Failure of treatment of group A streptococcal pharyngitis and tonsillitis is well documented. One of the possible explanations for treatment failure is penicillin tolerance in group A streptococci. Reports on the prevalence of penicillin tolerance among group A streptococci (0–100%) and the presumed relationship with therapeutic failure vary considerably. Therefore, it appears worthwhile to review pharyngotonsillitis studies, devoting special attention to the variables of MIC-MBC laboratory determinations such as inoculum preparation, composition and volume of test medium, and the criteria used to define penicillin tolerance. Alternative methods (gradient-replica plate method, β-lactamase disk test, time-kill assay, and cell-lysis assay) are discussed. It is concluded that technical factors and the definitions used influenced the reported rates of penicillin tolerance. The epidemiological data suggest that tolerance is not limited to a single streptococcal serotype. Furthermore, there is not sufficient data to support a correlation between in vitro penicillin tolerance of group A streptococci and treatment failure, either in clinical cases or in animal studies. On the other hand, evidence to exclude penicillin tolerance as a cause of treatment failure is also not available. Therefore, at present, penicillin tolerance cannot be ruled out as a cause of penicillin treatment failures.Keywords
This publication has 62 references indexed in Scilit:
- Association of penicillin-tolerant streptococci with epidemics of streptococcal pharyngitis in closed communitiesEuropean Journal of Clinical Microbiology & Infectious Diseases, 1989
- Degree and stability of tolerance to penicillin inStreptococcus pyogenesEuropean Journal of Clinical Microbiology & Infectious Diseases, 1989
- Bacteriological and serological aspects of group a streptococcal pharyngotonsillitis caused by group a streptococciEuropean Journal of Clinical Microbiology & Infectious Diseases, 1988
- Efficacy of benzathine penicillin G in group A streptococcal pharyngitis: ReevaluationThe Journal of Pediatrics, 1987
- Efficacy of β-lactamase-resistant penicillin and influence of penicillin tolerance in eradicating streptococci from the pharynx after failure of penicillin therapy for group A streptococcal pharyngitisThe Journal of Pediatrics, 1987
- Penicillin tolerant group a streptococciDiagnostic Microbiology and Infectious Disease, 1986
- Penicillin V and rifampin for streptococcal pharyngitisThe Journal of Pediatrics, 1985
- Association of penicillin tolerance with failure to eradicate group A streptococci from patients with pharyngitisThe Journal of Pediatrics, 1985
- Penicillin V and rifampin for the treatment of group A streptococcal pharyngitis: A randomized trial of 10 days penicillin vs 10 days penicillin with rifampin during the final 4 days of therapyThe Journal of Pediatrics, 1985
- Discrepancy between minimum inhibitory and minimum bactericidal concentrations of penicillin for group A and group B β-hemolytic streptococciThe Journal of Pediatrics, 1978