Glomerulonephritis Acute streptococcal

Parra G, Rodriguez-Iturbe B, Batsford S, et al. Antibody to streptococcal zymogen in the serum of patients with acute glomerulonephritis a multicentric study. Kidney Int 1998 54 509-517. 

Pharyngitis is the most common disease produced by S. pyogenes. Penicillin-resistant isolates of this organism have yet to be observed. The preferred oral therapy is with penicillin V, 500 mg every 6 hours for 10 days. Equal results are produced by the administration of 600,000 units of penicillin G procaine intramuscularly once daily for 10 days or by a single injection of 1.2 million units of penicillin G benzathine. Parenteral therapy is preferred if there are questions of patient compliance. Penicillin therapy of streptococcal pharyngitis reduces the risk of subsequent acute rheumatic fever but not of poststreptococcal glomerulonephritis. 

The interaction that results in neutralisation of the thrombolytics is established and clinically important. One author says that clinically, therapy is not repeated within a year as it would not work. Given that it has been suggested that the effects may be very persistent, it would seem prudent, if a second use is needed, to use a thrombolytic with less antigenic effects such as alteplase. The British National Formulary says that streptokinase should not be used again beyond 4 days of the first use of either streptokinase or anistreplase. In addition, the manufacturer recommends avoidance of streptokinase in patients who have had recent streptococcal infections that have produced high anti-streptokinase titres, such as acute rheumatic fever or acute glomerulonephritis. ... 

Biliary tract Biliary pseudolithiasis has been reported in three Chinese children with renal diseases, two with nephrotic syndrome and one with post-streptococcal glomerulonephritis with acute renal failure, who were given ceftriaxone [17 ]. 

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