rifampin and Pharyngitis

Therapy to eradicate pharyngeally carried group A streptococci (GAS) has increasingly been used in the management of institutional outbreaks and is now recommended for household contacts of patients with streptococcal toxic shock syndrome. In this randomized, controlled trial, contacts of patients with GAS infections were screened for pharyngeal GAS colonization. Those whose cultures were positive were randomized to receive either cefixime (8 mg/[kg.d]; maximum 400 mg) or rifampin (20 mg/kg; maximum, 600 mg) once a day for 4 days. Two to five days following completion of therapy, repeated cultures were negative for 13 (38%) of 34 rifampin recipients and 71 (77%; 95% CI, 69%-85%) of 97 cefixime recipients. At 10-14 days after treatment, only 53% of cefixime recipients remained culture-negative. Rates of successful clearance improved with increasing age (P < .01); among 17 adults who received cefixime, the success rate was 94%. Four days of therapy with rifampin is not effective for eradication of pharyngeally carried GAS. Four days of therapy with cefixime may be effective for adults, but further studies are needed.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cefixime; Cefotaxime; Child; Drug Administration Schedule; Humans; Pharyngitis; Rifampin; Streptococcal Infections; Streptococcus pyogenes

We previously demonstrated that chronic pharyngeal carriage of group A beta-hemolytic streptococci (GABHS) can be terminated by intramuscular administration of benzathine penicillin plus 4 days of orally administered rifampin. Because an effective oral regimen would be desirable, we compared clindamycin with P + R for treating GABHS carriage. Healthy, symptom-free GABHS carriers were randomly assigned to receive orally administered clindamycin (20 mg/kg per day) three times a day for 10 days or intramuscularly administered benzathine penicillin with oral doses of rifampin (20 mg/kg per day) twice a day for 4 days. Compliance was documented by antibiotic activity in urine. Throat cultures for GABHS were obtained every 3 weeks for up to 9 weeks after treatment. Patients who had positive throat cultures for their original GABHS T type 3 weeks after randomization were crossed over to the other treatment. Treatment success was defined as eradication of the original GABHS T type, with all follow-up cultures negative. Clindamycin eradicated carriage in 24 (92%) of 26 patients; penicillin plus rifampin was effective in 12 (55%) of 22 patients (p less than 0.025). Including patients crossed over 3 weeks after enrollment, clindamycin was effective in 28 (85%) of 33 treatment courses compared with 12 of 22 courses of penicillin plus rifampin (p less than 0.05). We conclude that 10 days of oral clindamycin therapy was significantly more effective than benzathine penicillin plus 4 days of orally administered rifampin for treatment of symptom-free GABHS carriers.

Topics: Administration, Oral; Adolescent; Carrier State; Child; Child, Preschool; Chronic Disease; Clindamycin; Drug Evaluation; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Penicillin G Benzathine; Pharyngitis; Rifampin; Streptococcal Infections; Streptococcus pyogenes

We evaluated the efficacy of rifampin in eradicating chronic pharyngeal carriage of group A streptococci. Carriers were defined as healthy children whose throat cultures showed persistence of group A streptococci 3 weeks after receiving benzathine penicillin G intramuscularly. Subsequent M and T typing of group A streptococcal isolates and limited serologic studies confirmed that enrolled patients were carriers. Thirty-eight carriers (37 completed the study) were randomly assigned to three groups: group 1 (13 patients) received no treatment; group 2 (10) received benzathine penicillin intramuscularly; group 3 (14) received benzathine penicillin intramuscularly plus rifampin orally (10 mg/kg twice a day for eight doses). Throat cultures were obtained every 3 weeks for at least 9 weeks. Group 2 and 3 patients who still had positive cultures 3 weeks after treatment were crossed to the opposite group. Cultures became negative in 93% (13 of 14) of patients in group 3, compared with 23% in group 1 and 30% in group 2 (P less than 0.001 and P less than 0.01, respectively). Including patients crossed over, the penicillin plus rifampin regimen was effective in 17 (89%) of 19 treatment courses and was significantly superior to no therapy or to penicillin alone (P less than 0.0005 and P less than 0.005, respectively). We conclude that rifampin plus benzathine penicillin intramuscularly is an effective regimen for those selected patients in whom eradication of group A streptococcal carriage is judged to be desirable.

Topics: Administration, Oral; Adolescent; Carrier State; Child; Child, Preschool; Drug Therapy, Combination; Follow-Up Studies; Humans; Injections, Intramuscular; Penicillin G; Penicillin G Benzathine; Pharyngitis; Random Allocation; Rifampin; Streptococcal Infections; Streptococcus pyogenes

To improve the bacteriologic and clinical cure rates of streptococcal pharyngitis, 79 children were randomly assigned to receive penicillin V alone for 10 days (39 patients) or penicillin for the same duration and rifampin during the last 4 days of penicillin therapy (40 patients). Eleven patients given penicillin had evidence of bacteriologic failure (including eight with relapse of clinical illness) on repeat cultures done 4 to 7 days after treatment, whereas there were no failures in children given combination therapy (P = 0.0015). All eight symptomatic children improved with penicillin-rifampin therapy and subsequent cultures were negative, whereas three asymptomatic children continued to harbor group A streptococci even after combination therapy. Antibody response by antistreptolysin O or antideoxyribonuclease B assay was seen in 50.6% of patients; the antibody responses in both groups were comparable. These results show that addition of rifampin to the penicillin regimen improves the clinical and bacteriologic cure rates in children with streptococcal pharyngitis.

Topics: Adolescent; Child; Child, Preschool; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Infant; Male; Penicillin V; Pharyngitis; Random Allocation; Recurrence; Rifampin; Serologic Tests; Streptococcal Infections; Streptococcus pyogenes

The incidence of acute rheumatic fever has seen a dramatic decline over the last 15 to 20 years in most developed countries and treatment of this disease has changed little since. The ease of travel and immigration and the cosmopolitan nature of many cities mean that occasionally the disease will come to the attention of clinicians not familiar with its presentation, resulting in delayed diagnosis and treatment. We present a case of recurrent acute rheumatic fever in a patient who was initially thought to be suffering from acute bacterial endocarditis on her previously diseased rheumatic aortic valve. This culminated in her undergoing urgent aortic valve replacement during a phase of the illness that should have been treated with high dose anti-inflammatory medication. Therefore, clinicians should be aware of this condition and include it in their differential diagnosis of the febrile patient with a previous history of rheumatic fever. We briefly discuss the diagnostic dilemma of patients suffering from this condition and in differentiating it from acute endocarditis.

Topics: Acute Disease; Adult; Amoxicillin; Anti-Inflammatory Agents; Aortic Valve; Aortic Valve Insufficiency; Arthralgia; Bangladesh; Clarithromycin; Diagnosis, Differential; Diagnostic Errors; Drug Therapy, Combination; Emigration and Immigration; Endocarditis, Bacterial; England; Female; Fever; Gentamicins; Heart Failure; Heart Valve Prosthesis Implantation; Humans; Penicillin G; Penicillin V; Pericarditis; Pharyngitis; Prednisone; Recurrence; Rheumatic Fever; Rheumatic Heart Disease; Rifampin; Unnecessary Procedures; Vancomycin

Topics: Anal Canal; Antibiotics, Antitubercular; Cellulitis; Child; Child, Preschool; Drug Resistance, Bacterial; Genotype; Humans; Male; Microbial Sensitivity Tests; Penicillins; Pharyngitis; Polymerase Chain Reaction; Rifampin; Streptococcal Infections; Streptococcus pyogenes

Based on evidence that patients with infections due to Haemophilus influenzae type b (HIB) remain colonized after therapy, recommendations for chemoprophylaxis of susceptible contacts have included providing rifampin for patients themselves. However, these recommendations have been made with neither definitive advice concerning the timing of rifampin administration nor any supporting data of efficacy and safety in patients. Our data suggest that rifampin given concurrently with therapeutic antimicrobials is as effective-89% (17/19)--as when given following therapeutic antimicrobials-95% (18/19)--in eradicating pharyngeal HIB. Colonization of the pharynx by HIB was also determined before and during therapy. Almost all patients were colonized before beginning therapy; most were heavily colonized. The density of colonization diminished rapidly during the first 15 to 20 hours of therapy. However, 28% of patients, primarily those who had HIB diseases other than meningitis or did not receive any chloramphenicol, still had detectable colonization after four to six days of antimicrobial therapy.

Topics: Cellulitis; Child, Preschool; Epiglottitis; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Meningitis, Haemophilus; Pharyngitis; Rifampin

Topics: Drug Therapy, Combination; Humans; Penicillin V; Pharyngitis; Rifampin; Streptococcal Infections

Topics: Carrier State; Cefaclor; Child; Drug Therapy, Combination; Erythromycin; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Pharyngitis; Rifampin; Sulfisoxazole

Topics: Aged; Diagnosis, Differential; Epiglottis; Esophageal Neoplasms; Hospitals, General; Humans; Ileocecal Valve; Isoniazid; Laryngeal Neoplasms; Laryngoscopy; Male; Otitis Media; Pharyngitis; Radiography; Respiratory Tract Infections; Rifampin; Tongue Diseases; Tonsillitis; Tuberculosis; Tuberculosis, Gastrointestinal; Tuberculosis, Laryngeal; Tuberculosis, Oral; Tuberculosis, Pulmonary

Topics: Abscess; Bronchopneumonia; Empyema; Enteritis; Humans; Pharyngitis; Pneumonia; Respiratory Tract Infections; Rhinitis; Rifampin; Skin Diseases