Streptococcal infections treatment

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. 

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. 

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. 

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. 

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

Group A beta-hemolytic streptococcal infections Do not use for treatment of these infections. 

Obstetric infections can be treated with penicillin-beta-lactamase inhibitors such as amoxicillin-clavulanic acid, with extended spectrum penicillins (with or without beta-lacamase inhibitors if justified by local resistance surveillance data), with a first or second generation cephalosporin combined with metronidazole. In severe cases of streptococcal infection high doses of penicillin in combination with clindamycin is the treatment of choice. In amnionitis, maternal morbidity resolves with delivery. In endometritis, antibiotics should be stopped after the... 

Tetracyclines no longer can be entirely relied on in the treatment of streptococcal infections up to 40% of Streptococcus pyogenes and 10% of Streptococcus pneumoniae are resistant. 

Erythromycin is effective in the treatment and prevention of S. pyogenes and other streptococcal infections, but not those caused by the more resistant fecal streptococci. Staphylococci are generally susceptible to erythromycin, so this antibiotic is a suitable alternative drug for the penicillin-hypersensitive individual. It is a second-line drug for the treatment of gonorrhea and syphilis. Although erythromycin is popular for the treatment of middle ear and sinus infections, including H. influenzae, possible erythromycin-resistant S. pneumoniae is a concern. 

Although the first-generation cephalosporins are broad spectrum and relatively nontoxic, they are rarely the drug of choice for any infection. Oral drugs may be used for the treatment of urinary tract infections, for staphylococcal, or for streptococcal infections including cellulitis or soft tissue abscess. However, oral cephalosporins should not be relied on in serious systemic infections. 

Prevention of streptococcal infections in patients with a history of rheumatic heart disease. Patients may require 20 years of treatment. 

Ceftiofur is marketed as a "new" generation cephalosporin as it does not clearly fall into the previous classification scheme. It is currently approved for the treatment of streptococcal infections in horses. It has broader Gram-positive spectrum of activity than the third-generation cephalosporins and has activity against anaerobes. Ceftiofur has no activity against Pseudomonas spp. and does not penetrate into the CNS. It is metabolized very rapidly in vivo to its active metabolite desfuroylceftiofur. Desfuroylceftiofur is very highly protein bound because of a sulfhydryl... 

Herring E, Gefeller O, Land M, et al. Surfactant treatment of neonates with respiratory failure and group B streptococcal infection. Members of the Collaborative European Multicenter Study Group. Pediatrics 2000 106 957-964. 

Chamovitz R, Catanzaro El, Stetson CA, et al. Prevention of rheumatic fever by treatment of previous streptococcal infections. N Engl J Med 1954 251 466-471. 

The first cancer vaccine was used by W.B. Coley in the 1890s who, based on his observation that in some cancer patients advanced tumours disappeared following acute streptococcal infection, used a mixture of several bacterial strains and injected straight into tumours. The treatment had varying success to cure established solid tumours. The reason why this treatment may have worked in some patients did not become clear until the 1980s when bacterial... 

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