Local children getting strep throat that resists common antibiotics

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Local children getting strep throat that resists common antibiotics

Thursday, April 18, 2002

By Anita Srikameswaran, Post-Gazette Staff Writer

Local doctors continue to see area schoolchildren with strep throat caused

by bacteria that has grown resistant to some popular antibiotics.

Federal infectious disease experts yesterday said they are interested in

joining with the researchers from Children's Hospital to investigate the

strain, which was first found here.

Researchers from Children's first reported in December that nearly half of

the cases of strep throat in a group of schoolchildren they are studying was

caused by bacteria that couldn't be killed by erythromycin, an antiobiotic

that is commonly prescribed for those allergic to penicillin, which is the

first-line treatment.

Those findings, based on data gathered from October 2000 to May 2001, are

being published today in the New England Journal of Medicine.

Researchers led by Dr. Judith have continued checking for the

resistant strain among children in the study, which monitors strep

infections in students in kindergarten through eighth grade at an

undisclosed school. The study entered its fourth year in October.

" We're still seeing tons of it in the school, " she said. " It hasn't gone

away. "

Strep throat season typically begins in February or March, but got a late

start this year, added.

Now that the infection is going around, Dr. Van Beneden, a medical

epidemiologist with the U.S. Centers for Disease Control and Prevention,

said she and might soon begin work to identify risk factors for

having the resistant strain.

After the findings were first announced several months ago, 's team

sent a letter warning area physicians of the problem. Many heeded it by

prescribing alternate drugs, such as clindamycin, for strep throat patients

allergic to penicillin, instead of so-called macrolide drugs such as

erythromycin or azithromycin, commonly known as the Z-pack, said.

In other countries, the increased use of macrolides, in particular the

convenient once-daily, five-day Z-pack, corresponded with the development of

resistant bacterial strains. The problem diminished when the drugs were used

less frequently.

said that there are indications that macrolide use is on the rise

locally and in the United States, but no direct evidence has linked it with

the resistant strain seen here.

Still, " this is a plea to the public to not ask for antibiotics when it's

not necessary because certainly [overuse] contributes to things like this, "

she said.

Strep throat, which is caused by bacteria called Group A streptococci, will

go away on its own. It is treated, though, to prevent the development of

rheumatic fever, in which the bacteria infect heart valves or other tissues.

With perhaps 10 to 12 annual cases, " Pittsburgh is a hotbed of rheumatic

fever " compared to other cities, said. That could be due to a

familial predisposition or because the area has more bacterial strains that

can lead to the disease.

She noted that the macrolide-resistant strain does have the potential to

cause rheumatic fever, but there has not been an increase in cases lately.

Dr. Penti Huovinen of the National Public Health Institute in Turku,

Finland, suggested that doctors could help assess antibiotic resistance by

ordering traditional tests for strep rather than just the popular rapid

test, which indicates only that Group A strep is present.

" We may need to go back to the practice of obtaining throat swabs for

bacterial culture so that [antibiotic] susceptibility testing can be

performed, " he wrote in commentary for the medical journal.

hoped that researchers elsewhere would check for resistance in their

own communities after study findings were first reported five months ago.

She hasn't heard that anyone else is looking yet, however.

" It might not be a big problem nationwide. Maybe it's Pittsburgh specific, "

she said. " We have no clue right now. "

A CDC research team led by Van Beneden has been testing Group A strep

samples collected at seven national centers in 1999 from infections of the

bloodstream and central nervous system.

They found that the rate of erythromycin resistance varied from 3 percent to

14 percent. Van Beneden said that a similar review will be conducted on 2001

samples to look for changes with time.

http://www.post-gazette.com/healthscience/20020418strep2.asp