Amoxicillin for throat pain

It is really impossible for me to imagine what the world would be like without penicillin. I question whether there would be a discipline of infectious diseases as we know it today.

There were beginning treatments for pneumococcal pneumonia in the 1930s with antisera and sulfonamides, but use of these treatments quickly came to a halt, and everyone began using penicillin. This quickly led to a number of pharmaceutical industries beginning to screen a variety of other natural products for antibacterial activity, which led to a whole host of new antibiotics, such as streptomycin, aminoglycosides, tetracycline and the like. Penicillin clearly led the way in that development. It is interesting that using penicillin for the treatment of infections like pneumococcal pneumonia and bacterial endocarditis never had a randomized, controlled trial because the difference with treatment was so clearly apparent that no one even thought of doing a randomized controlled trial. Chief, Infectious Diseases Section, Veterans Affairs Medical Center, Boise, ID and. Professor of Medicine, University of Washington School of Medicine, Seattle, WA. Stevens, Ph.D., M.D., Infectious Diseases Section, Veterans Affairs Medical Center, 500 West Fort St.

(Bldg 45), Boise, ID 83702; phone: 208-422-1599; fax: 208-422-1365; This material is based upon work supported by the Office of Research and Development, Medical Research Service, Department of Veterans Affairs. Streptococcus pyogenes , or Group A streptococcus (GAS), is a facultative, Gram-positive coccus which grows in chains and causes numerous infections in humans including pharyngitis, tonsillitis, scarlet fever, cellulitis, erysipelas, rheumatic fever, post-streptococcal glomerulonephritis, necrotizing fasciitis, myonecrosis and lymphangitis.

The only known reservoirs for GAS in nature are the skin and mucous membranes of the human host.

The clinical diseases produced by GAS have been well described, however, the pathogenic mechanisms underlying them are poorly understood, largely because each is the culmination of highly complex interactions between the human host defense mechanisms and specific virulence factors of the streptococcus. Group A streptococci require complex media containing blood products, grow best in an environment of 10% carbon dioxide and produce pinpoint colonies on blood agar plates which are surrounded by a zone of complete (beta) hemolysis. The exhaustive work of Rebecca Lancefield established the classification of streptococci into types A through O based upon acid extractable carbohydrate antigens of cell wall material (51).

In addition, GAS have also been subdivided based upon the

surface

High resolution genotyping provides a more specific determination of relatedness among strains isolated from outbreaks of GAS infections (65). Finally rapid, sequencing of the gene encoding M-protein is providing a rapid definitive way of comparing M-typeable and M-non-typeable strains (5,27).

Group A ?-hemolytic streptococcus (GABHS, Streptococcus pyogenes ) is a

common

occurred

However, over the past 15 years, there has been a resurgence in the incidence of severe invasive group A streptococcal infections (77,87).

These include necrotizing fasciitis, myositis, toxic shock syndrome, and streptococcal bacteremia.

In addition, since the early 1980s, an increase in reports of individual cases of acute rheumatic fever (ARF)

have

However, there is a general consensus that the

number

This resur­gence has been partly attributed to a change in the epidemiol­ogy of group A streptococcus as well as a change in the viru­lence of the organism (81). Some have suggested that changes in the susceptibility of group A streptococci to com­monly used antibiotics may have contributed as well (57,75). ­The increased number and severity of group A strep­tococcal infections present special challenges to both the general practitioner and the infectious disease specialist, and the treatment of group A streptococcal infections has taken on greater importance. S carlet Fever: Scarlet fever has its highest prevalence in children 4 - 8 years of age and is very uncommon in adults. The primary infection most commonly associated with scarlet fever is pharyngitis, though soft tissue infection at a surgical site has been described (surgical scarlet fever).

A cute Rheumatic Fever: Large epidemics of scarlet fever have been reported in the literature since the 12 and 13th centuries in association with childbed fever, non-pasteurized milk, surgical wards, schools, day care centers and certainly among family members.

The transmission in non-hospitalized patients is usually via the oral route from droplets from primary cases or from ingestion of milk contaminated with toxin producing strains of GAS.

Reductions in incidence and mortality rates of ARF in the United States had begun prior to the discovery of penicillin, primarily because of improved housing, sanitation, and delivery of health care. The recent increase in incidence of ARF in the United States has occurred primarily in children of middle c­lass families (89).

However, the use of penicillin in the treatment of GAS pharyngitis dramatically reduced the incidence of ARF.

Mucoid colonies of group A streptococci have been associated with cases of rheumatic fever in North America but not in de­veloping countries. Five serotypes have predominated: M-1, M-3­, M-18, M-5, and M-6.

Types M- 5 and M-18 have been re­ported as most consistently mucoid (77,87,89). S treptococcal Toxic Shock Syndrome (StrepTSS): Several population-based studies of StrepTSS have documented the annual incidence of 1-5 cases per 100,000 population (74) with most cases being sporadic in nature, however, larger epidemics of invasive Group A streptococcal infections have also been described in some settings.