erythromycin-estolate and Pharyngitis

Children with suspected group A beta-hemolytic streptococcal pharyngitis are encountered daily in outpatient settings. Despite the ubiquity of this condition, important management issues still remain unresolved. This article will review selected epidemiologic, diagnostic, and therapeutic topics germane to clinical practice.

Topics: Agglutination Tests; Child; Drug Administration Schedule; Erythromycin Estolate; Humans; Immunosorbent Techniques; Penicillin G Benzathine; Pharyngitis; Predictive Value of Tests; Reagent Kits, Diagnostic; Streptococcal Infections; Streptococcus pyogenes

In a randomized, prospective, multicenter trial, 227 children ranging in age from 3 to 17 years who had tonsillopharyngitis and a throat culture positive for group A beta-hemolytic streptococci (GABHS) were treated with erythromycin estolate (40 mg/kg/d in two divided doses for five days) or penicillin V (30 mg/kg/d in three divided doses for ten days). Clinical signs and symptoms of tonsillopharyngitis were recorded, and throat cultures were obtained before treatment as well as one to three days and six weeks after treatment. Clinical success (cure and improvement) was observed on days 6 to 8 in 100 of 102 (98%) assessable children treated with erythromycin estolate and on days 11 to 13 in 97 of 99 (98%) assessable children treated with penicillin V. Of all patients showing clinical success, 11 were rated as improved, all of whom were treated with erythromycin estolate. There was a trend towards increased use of analgesic treatment in the erythromycin estolate group (41% vs 33%). On completion of treatment, the rate of eradication of GABHS was 83.3% in the erythromycin estolate group compared with 87.9% in the penicillin V group. The difference is not significant but does not take into account patients excluded because of erythromycin resistance (3.7%). Clinical recurrence was observed in 11 (10.8%) patients treated with erythromycin estolate and in 6 (6.1%) patients treated with penicillin V (non-significant difference). Compliance in the erythromycin estolate group was statistically superior to that in the penicillin V group. The incidence and nature of adverse events were similar in both treatment groups.

Topics: Administration, Oral; Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Drug Administration Schedule; Erythromycin Estolate; Female; Humans; Male; Penicillin V; Penicillins; Pharyngitis; Prospective Studies; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis; Treatment Outcome

To determine if it is appropriate to recommend that patients with group A beta-hemolytic streptococcal pharyngitis, who are clinically well by the morning after starting antibiotic treatment, can return to school or day care, or if they should wait until they have completed 24 hours of antibiotics as recommended by the American Academy of Pediatrics Committee on Infectious Diseases.. We examined the duration of positivity of the throat culture after antibiotics were begun as a means of assessing the potential risk of transmission to close school contacts. Forty-seven children (4 to 17 years of age) with pharyngitis and a positive throat culture for group A streptococci in an outpatient, staff model health maintenance organization clinic were enrolled and were randomly selected to receive therapy with either oral penicillin V, intramuscular benzathine penicillin G, or oral erythromycin estolate. Additional throat cultures were obtained and clinical findings were recorded for each child during three home visits in the 24 hours after their initial clinic visit. Acute and convalescent sera were obtained for determination of anti-streptolysin O and anti-DNase B titers.. Seventeen (36.2%) of the 47 patients had a positive culture the morning after initiating antibiotic therapy. However, thirty-nine (83%) of the patients became "culture negative" within the first 24 hours. Neither the time interval to the first negative culture nor the presence or absence of group A streptococcal organisms on any single convalescent culture could be predicted by clinical findings. Six of the eight children who failed to convert to a "negative" throat culture within 24 hours of initiating therapy were receiving erythromycin. We could detect no difference in either time to conversion to a negative culture or the presence of a positive culture 24 hours after starting antibiotics between those who demonstrated a significant antibody increase and those who did not.. The data from this study strongly suggest that children with group A beta-hemolytic streptococcal pharyngitis should complete a full 24 hours of antibiotics before returning to school or daycare.

Topics: Adolescent; Child; Child, Preschool; Erythromycin Estolate; Humans; Penicillin G Benzathine; Penicillin V; Pharyngitis; Pharynx; Prospective Studies; Streptococcal Infections; Streptococcus pyogenes; Time Factors

Topics: Adolescent; Amoxicillin; Ampicillin; Child; Child, Preschool; Clinical Trials as Topic; Drug Administration Schedule; Drug Evaluation; Erythromycin; Erythromycin Estolate; Female; Humans; Infant; Leukocyte Count; Male; Penicillin V; Pharyngitis; Streptococcal Infections

One hundred two children with group A streptococcal pharyngitis were treated on a randomized basis with either 15 mg/kg of erythromycin estolate or 25 mg/kg of erythromycin ethylsuccinate given twice daily for ten days. Twelve patients, including 11 erythromycin ethylsuccinate-treated patients and one erythromycin estolate-treated patient, were dropped from the study at the request of their parents because of abdominal cramping and/or nausea and vomiting that occurred 15 to 45 minutes after ingestion of drug. Eighteen other patients (12 treated with erythromycin ethylsuccinate and six treated with erythromycin estolate) had similar gastrointestinal (GI) tract symptoms that resolved or abated. Excluding patients with reinfections with new streptococcal serotypes and those with resistant strains, the bacteriologic failure rates were 4.3% and 17.5%, and the total failure rates were 6.4% and 35.3% with erythromycin estolate therapy and with erythromycin ethylsuccinate therapy, respectively. The high rate of GI tract intolerance associated with the erythromycin ethylsuccinate appears to be dose related.

Topics: Adolescent; Child; Child, Preschool; Drug Resistance, Microbial; Erythromycin; Erythromycin Estolate; Erythromycin Ethylsuccinate; Female; Humans; Male; Patient Compliance; Pharyngitis; Prospective Studies; Random Allocation; Streptococcal Infections; Streptococcus pyogenes

The recommended dosage of erythromycin, without regard to the formulation prescribed, for children with streptococcal pharyngitis is 30 to 40 mg/kg/day. We previously reported an acceptable streptococcal eradication rate among patients with pharyngitis treated with erythromycin estolate, 20 mg/kg/day. In this study, an extension of the earlier one, the efficacy of this same dosage of erythromycin estolate was compared with a 40 mg/kg/day dosage of erythromycin ethylsuccinate. Streptococcal eradication rates were nearly identical in the two groups of patients. The efficacy of erythromycin estolate at a dosage lower than that recommended for children is most likely explained on pharmacologic grounds: better absorption and higher levels in serum and tissue than those achieved with other erythromycin formulations. It seems rational to calculate required dosages of erythromycin on the basis of the formulation being administered.

Topics: Antibodies, Bacterial; Child; Erythromycin; Erythromycin Estolate; Humans; Pharyngitis; Serotyping; Streptococcal Infections; Streptococcus pyogenes; Succinates

Streptococcal eradication rates of 86% were demonstrated in 97 patients seen on day 14 and in 73 patients seen on both days 14 and 28 after a ten-day course of erythromycin estolate therapy given at a dosage of 20 mg/kg/day, administered in two equal doses. The efficacy of this regimen compares favorably with other results in which this and other erythromycin preparations have been employed at higher doses, usually in the range of 30 to 50 mg/kg/day. Our reported effectiveness at a lower than usual dose of erythromycin is probably explained by the following factors: the known susceptibility of group A streptococci to low concentrations of erythromycin, the uniform absorption of the estolate formulation of erythromycin, and adequate compliance in adhering to the treatment regimen by the majority of our patients. This dosage schedule of erythromycin is simple to administer; and a reduction by half of the total dose usually recommended provides an economical advantage for patients.

Topics: Erythromycin; Erythromycin Estolate; Humans; Microbial Sensitivity Tests; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes; Time Factors

A 43-year-old male developed abdominal pain and jaundice after the administration of erythromycin estolate. The diagnosis was strongly suspected on clinical grounds, but ultimate confirmation depends upon the demonstration of biochemical and morphological alterations after challenge with the drug.

Topics: Abdomen; Acute Disease; Adult; Bile Ducts; Biopsy, Needle; Endoplasmic Reticulum; Erythromycin; Erythromycin Estolate; Glycogen; Humans; Jaundice; Liver; Liver Function Tests; Male; Microscopy, Electron; Microscopy, Fluorescence; Pain; Pharyngitis; Recurrence

Topics: Acute Disease; Child; Drug Therapy; Erythromycin; Erythromycin Estolate; Humans; Penicillin V; Penicillins; Pharyngitis; Scarlet Fever; Streptococcal Infections