Evaluation of Short-Course Therapy with Cefixime or Rifampin for Eradication of Pharyngeally Carried Group A Streptococci

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 w...

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Bibliographic Details
Published in:Clinical infectious diseases 1995-11, Vol.21 (5), p.1294-1296
Main Authors: Davies, H. Dele, Low, Donald E., Schwartz, Benjamin, Scriver, Shelley, Fletcher, Aileen, O'Rourke, Keith, Ipp, Moshe, Goldbach, Morton, Lloyd, David, Saunders, Norman R., Greenberg, Saul, Farber, Robert, Tannenbaum, David W., Talbot, James, McGeer, Allison
Format: Article
Language:English
Subjects:
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Biological and medical sciences
Children
Disease outbreaks
Epidemiology
Infections
Infectious diseases
Medical sciences
Medications
Microbiology
Nursing homes
Pediatrics
Pharmacology. Drug treatments
Preventive medicine
Streptococcus
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Summary: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.
ISSN:1058-4838
1537-6591
DOI:10.1093/clinids/21.5.1294