THE ROLE OF THE CARRIER IN TREATMENT FAILURES AFTER ANTIBIOTIC-THERAPY FOR GROUP-A STREPTOCOCCI IN THE UPPER RESPIRATORY-TRACT

  • 1 January 1981
    • journal article
    • research article
    • Vol. 98  (3) , 326-335
Abstract
During a prospective study of endemic group A streptococcal upper respiratory tract infection and the streptococcal carrier state, the persistence of group A streptococci was investigated after treatment with recommended doses of antibiotics. Clinical findings, culture results and streptococcal antibody responses at the acute-stage clinic visit and at convalescent-stage visits 3 and 8 wk later were evaluated. Data from 280 children ill with pharyngitis and their family contacts were analyzed (mean age 13.3 years); 129 individuals (46%) had group A .beta.-hemolytic streptococci isolated at the initial visit. Despite antibiotic treatment, group A streptococci were not eradicated from the upper respiratory tract of 34 (26%) of the 129 culture-positive individuals. Thirteen of the 34 (38%) required a 2nd course of antibiotic therapy before the infecting serotype was eradicated, but most, the remaining 21 (62%) patients, were not bacteriologically cured despite repeated courses of antibiotics. Streptococcal antibody data suggested that most of the treatment failures were streptococcal carriers. Only 5% of asymptomatic individuals with a positive culture for group A streptococci demonstrated an antibody rise. These bacteriologic and serologic data document that it usually is unnecessary to retreat asymptomatic convalescent individuals having throat cultures persistently positive for group A streptococci, since these individuals seldom represent true streptococcal infection.