Streptococcal infection

QHgNiOiS. Colourless crystals, m.p. 164 5-166-5" C. It is usually prepared by treating p-acetamidobenzenesulphonyl chloride with ammonia, and hydrolysing the acetyl derivative to the base. Used for the treatment of streptococcal infections, gonorrhoea, meningococcal meningitis and urinary infections. Liable to cause unpleasant reactions, such as nausea, cyanosis and skin rashes. 

These neutralizing antibodies may arise because of a prior streptococcal infection, or prior streptokinase treatment (80—82). Titers of antibodies sufficient to neutralize a complete dose of 1.5 million units of streptokinase may be present even one year after enzyme treatment (83). 

Compared to streptokinase, urokinase has been less extensively studied because of its high cost, ie, about 10 times that of a comparable treatment with streptokinase. In addition to the indications described for streptokinase, urokinase is indicated for use in patients with prior streptokinase treatment, or prior Streptococcal infection. Urokinase is commonly used at a loading dose of 4400 units /kg, with a maintenance intravenous infusion dose of 4400 units/kg/h for thromboses other than acute myocardial infarction. In the latter case, a much larger dose, ie, 0.5—2.0 million units/h or a bolus dose of 1.0 million units followed by a 60-min infusion with 1.0 million units, has been found optimal (106). An intracoronary dose of 2000 units/min for two hours was used in one comparative study with intracoronary streptokinase (107). In this study, urokinase exhibited efficacy equivalent to streptokinase with fewer side effects. Other studies with intracoronary urokinase have adrninistered doses ranging from 2,000 to 24,000 units/min with a reperfusion efficacy of 60—89% (108—112). In another urokinase trial, 2.0 million units were adrninistered intravenously, resulting in a thrombolytic efficacy of 60% (113). Effectiveness in terms of reduction in mortaUty rate has not been deterrnined because of the small number of patients studied. 

SB S8 S08.020 C5a peptidase Proposed target for vaccine against group B streptococcal infection... 

Scarlet fever is produced following infection with certain strains of Strep, pyogenes. These produce a potent toxin which causes an erythrogenic skin rash which accompanies the more usual effects of a streptococcal infection. 

Acute pharyngitis presents a diagnostic and therapeutic dilemma. The majority of sore throats are caused by a variety of viruses fewer than 20% are bacterial and hence potentially responsive to antibiotic therapy. However, antibiotics are widely prescribed and this reflects the difficulty in discriminating streptococcal from non-streptococcal infections clinically in the absence of microbiological documentation. Nonetheless, Strep, pyogenes is the most important bacterial pathogen and this responds to oral penicillin. However, up to 10 days treatment is required for its eradication fixm the throat. This requirement causes problems with compliance since symptomatic improvement generally occurs within 2-3 days. 

Staphylococcus aureus is responsible for a variety of skin infections which require therapeutic approaches different from those of streptococcal infections. Staphylococcal celluhtis is indistinguishable clinically from streptococcal cellulitis and responds to cloxacillin or flucloxacillin, but generally fails to respond to penicillin owing to penicillinase (/3-lactamase) production. Staphylococcus aureus is an important cause of superficial, localized skin sepsis which varies ftom small pustules to boils and occasionally to a more deeply invasive, suppurative skin abscess known as a carbuncle. Antibiotics are generally not indicated for these conditions. Pustules and boils settle with antiseptic soaps or creams and often discharge spontaneously, whereas carbuncles frequently require surgical drainage. Staphylococcus aureus may also cause... 

Cuttate psoriasis presents as a sudden eruption of small, disseminated erythematosquamous papules and plaques, and is often preceded by a streptococcal infection 2 to 3 weeks prior. 

Rheumatic fever An acute inflammatory disease involving the joints, heart, skin, and other tissues caused by an immune response to streptococcal infection, particularly seen in children. 

Scarlatiniform rash Bright, scarlet-colored skin eruption that occurs in patches over the entire body with eventual peeling as a result of streptococcal infection. 

Licosamides Clindamycin and lincomycin Serious staph-, pneumo-, and streptococcal infections in penicillin-allergic patients, also anaerobic infections... 

Macrolide Azithromycin, erithromycin, and telithromycin Streptococcal infections, lower and upper respiratory tract infections and pneumonia... 

P -Lactam and penicillins Amoxicillin, novamax Wide range of streptococcal infections, syphilis and Lyme diseases... 

As streptococcal cellulitis is indistinguishable clinically from staphylococcal cellulitis, administration of a semisynthetic penicillin (nafrillin or oxacillin) or first-generation cephalosporin (cefazolin) is recommended until a definitive diagnosis, by skin or blood cultures, can be made (Table 47-4). If documented to be a mild cellulitis secondary to streptococci, oral penicillin VK, or intramuscular procaine penicillin may be administered. More severe streptococcal infections should be treated with IV antibiotics (such as ceftriaxone 50 to 100 mg/kg as a single dose). 

LeVine, A.M., et al., Surfactant protein A-deficient mice are susceptible to group B streptococcal infection, J. Immunol. 158, 9, 4336, 1997. 

Persuasive proof of sulfanilamide s true antibacterial prowess came from Leonard Colebrook and his team of researchers in the maternity ward of Queen Charlotte s Hospital in London (7, 8, 9). Managing to obtain samples of Prontosil late in 1935, Colebrook quickly demonstrated the drug s remarkable effectiveness in curbing puerperal fever. The utility was soon expanded to other severe streptococcal infections. 

The majority of streptococcal infections occurred in children under ten, so the new drug proved a particular blessing to the very young (20). The big tablets of sulfanilamide could be administered successfully in hospitals to all but the smallest babies. Most sick children, however, received treatment at home, and mothers found it difficult to get them to swallow large pills. This circumstance seemed to call for a liquid dosage form. A number of attempts to find a suitable vehicle, however, proved unavailing. 

Streptococcal infections 1.2 MU IM. Many streptococcal strains are now resistant to penicillin. 

Boyle et al. (2001) used the Ciphergen SELDI protein chip to analyze the secretion and autoactivation of a cysteine protease (SpeB) from Streptococcus pyogenes that has been implicated in the onset of group A streptococcal infections and may contribute to toxic shock symptoms. SpeB could be detected at 0.75 ng protein in a 30-min assay based upon SELDI-TOF... 

This drug is used for pneumococcal, staphylococcal, and streptococcal infections as well as for sepsis, gonorrhea, and other infectious diseases. Synonyms of this drug are sulfadi-amezin and sulfadimidin. 

Serious streptococcal infections, such 150,000 units/kg/day divided in as pneumonia and endocarditis (S. equal doses every 4 to 6 h pneumoniae) and meningococcus... 

Streptococcal infections (group Adults 600,000 to 1 million units/day... 

Streptococcal infections - Treatment with the recommended dosage is usually given in a single session using multiple IM sites when indicated. An alternative dosage schedule may be used, giving half the total dose on day 1 and half on day 3. This will also ensure adequate serum levels over a 10-day period however, use only when the patient s cooperation can be ensured. 

Streptococcal Infections Therapy must be sufficient to eliminate the organism (minimum, 10 days) otherwise, sequelae (eg, endocarditis, rheumatic fever) may occur. 

Pharyngitis, tonsiiiitis 30 mg/kg/day in single or 2 divided doses. For -hemolytic streptococcal infections, continue treatment for at least 10 days. 

Streptococcal infections - Treat streptococcal infections for at least 10 days. 

Oral- When used in streptococcal infections, continue therapy for 10 days. 

Prevention of recurrent attacks of rheumatic fever- Prevention of recurrent attacks of rheumatic fever (not for initial treatment of streptococcal infections) Patients greater than 30 kg (greater than 66 lbs) -1 g/day less than 30 kg (less than 66 lbs) - 0.5 g/day. 

---