HYPERENDEMIC STREPTOCOCCUS-PYOGENES INFECTION DESPITE PROPHYLAXIS WITH PENICILLIN-G BENZATHINE

被引:47
作者
GRAY, GC
ESCAMILLA, J
HYAMS, KC
STRUEWING, JP
KAPLAN, EL
TUPPONCE, AK
机构
[1] USN,ENVIRONM & PREVENT MED UNIT 5,DEPT EPIDEMIOL,SAN DIEGO,CA 92132
[2] USN,ENVIRONM & PREVENT MED UNIT 5,DEPT MICROBIOL,SAN DIEGO,CA 92132
[3] USN,MED RES UNIT,BETHESDA,MD 20814
[4] UNIV MINNESOTA,DEPT PEDIAT,WHO,COLLABORATING CTR REFERENCE & RES STREPTOCOCCI,MINNEAPOLIS,MN 55455
关键词
D O I
10.1056/NEJM199107113250204
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. In closely confined populations, in which epidemics of Streptococcus pyogenes infection are common, penicillin G benzathine has long been used prophylactically to reduce morbidity from this pathogen. We report on our investigations of the effectiveness of penicillin G benzathine prophylaxis at a military recruit camp. Methods. We prospectively studied the rates of pharyngeal colonization and infection by S. pyogenes among 736 male U.S. Marine Corps recruits from January through March 1989. Throat swabs for culture, clinical data, and questionnaire data were obtained during six examinations at intervals of two weeks. Serum samples obtained before training, after training, and from acutely ill recruits were analyzed with use of an antistreptolysin O microtitration technique. Results. Although 93 percent of the recruits received prophylaxis with two intramuscular injections of 1.2 million units of penicillin G benzathine each (administered 30 to 39 days apart), 33 percent of the recruits were colonized by S. pyogenes, and 42 percent had infection (as defined by a two-dilution increase in the antistreptolysin O titer). Thirty-seven percent of 265 recruits who reported a sore throat and were infected with S. pyogenes did not seek medical attention. The recruits who were allergic to penicillin (7 percent of the total), who received no prophylaxis, were more likely to be colonized; an increased risk of colonization and infection among the nonallergic recruits was associated with the presence of a higher percentage of allergic recruits in the platoon. After the study was completed, all recruits who were allergic to penicillin were prescribed 250 mg of oral erythromycin twice daily (a total daily dose of 500 mg) for 60 days. Subsequently, the average weekly rate of clinically evident S. pyogenes pharyngitis fell by more than 75 percent. Conclusions. If the prevention of S. pyogenes infection is to be effective in closely confined populations such as military recruits, prophylactic antibiotics must be administered to all members of the population. Exempting those who are allergic to penicillin may create a bacterial reservoir from which infection can be transmitted to nonallergic members of the population.
引用
收藏
页码:92 / 97
页数:6
相关论文
共 46 条
[1]   PROPHYLAXIS IN PATIENTS WITH RHEUMATIC-FEVER - EVERY 3 OR EVERY 4 WEEKS [J].
AYOUB, EM .
JOURNAL OF PEDIATRICS, 1989, 115 (01) :89-91
[2]   TOXIC STREP SYNDROME - A MANIFESTATION OF GROUP-A STREPTOCOCCAL INFECTION [J].
BARTTER, T ;
DASCAL, A ;
CARROLL, K ;
CURLEY, FJ .
ARCHIVES OF INTERNAL MEDICINE, 1988, 148 (06) :1421-1424
[3]   THE RISE AND FALL (AND RISE QUESTIONABLE) OF RHEUMATIC-FEVER [J].
BISNO, AL ;
SHULMAN, ST ;
DAJANI, AS .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1988, 259 (05) :728-729
[4]  
BISNO AL, 1986, RESPIRATORY INFECTIO, V5, P217
[5]   STUDIES ON THE PREVENTION OF RHEUMATIC FEVER - THE EFFECT OF TIME OF INITIATION OF TREATMENT OF STREPTOCOCCAL INFECTIONS ON THE IMMUNE RESPONSE OF THE HOST [J].
BROCK, LL ;
SIEGEL, AC .
JOURNAL OF CLINICAL INVESTIGATION, 1953, 32 (07) :630-632
[6]   USE OF BENZATHINE PENICILLIN-G IN CARRIERS OF GROUP-A BETA-HEMOLYTIC STREPTOCOCCI [J].
BROOKS, TJ ;
MOE, TI .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1956, 160 (03) :162-165
[7]   PREVENTION OF RHEUMATIC FEVER BY TREATMENT OF PREVIOUS STREPTOCOCCAL INFECTION .1. EVALUATION OF BENZATHINE PENICILLIN-G [J].
CHAMOVITZ, R ;
CATANZARO, FJ ;
STETSON, CA ;
RAMMELKAMP, CH .
NEW ENGLAND JOURNAL OF MEDICINE, 1954, 251 (12) :466-471
[8]   CLINICAL AND BACTERIOLOGICAL OBSERVATIONS OF A TOXIC SHOCK-LIKE SYNDROME DUE TO STREPTOCOCCUS-PYOGENES [J].
CONE, LA ;
WOODARD, DR ;
SCHLIEVERT, PM ;
TOMORY, GS .
NEW ENGLAND JOURNAL OF MEDICINE, 1987, 317 (03) :146-149
[9]  
DAJANI AS, 1989, PEDIATR INFECT DIS J, V8, P263
[10]   BENZATHINE PENICILLIN-G - ITS EFFECTIVENESS IN THE PREVENTION OF STREPTOCOCCAL INFECTIONS IN A HEAVILY EXPOSED POPULATION [J].
DAVIS, J ;
SCHMIDT, WC .
NEW ENGLAND JOURNAL OF MEDICINE, 1957, 256 (08) :339-342