Strep and TS rethought-article
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FYI- Best, Jo (Happy Pesach and Happy Easter to all) Doctors urged to rethink treatment for strep throat New class of antibiotics more effective than ‘gold standard’ penicillin Sharon Kirkey CanWest News Service Monday, April 05, 2004 Canadian pediatricians are being urged to rethink the way they treat strep throat, one of the most common bacterial infections in children. A major new study has found a new class of antibiotics is three times more effective than "gold standard" penicillin at eradicating the germs that cause strep throat. The findings, published today in the journal Pediatrics, go against guidelines that for 50 years have pushed penicillin as the treatment of choice for strep throat, despite studies beginning in the early 1980s that show an increase in the number of sore throats not cured by penicillin. The new research, based on a review of 35 studies involving more than 7,000 children, found the odds of treatment failure were nearly three times higher with penicillin than with a newer generation of antibiotics called cephalosporins. Lead author Dr. Janet Casey, a University of Rochester Medical Center pediatrician, says many doctors who still preach penicillin first "aren’t in the trenches anymore seeing sick children every day." In an interview, Casey said she has noticed a growing number of children who finish their penicillin, "and within 24, 48, 72 hours they’re right back where they started." Meantime, a second study published in today’s edition of Pediatrics warns there’s not enough evidence to prove a strep infection can trigger tics or psychiatric problems in children. A potential link surfaced several years ago, when researchers from the U.S. National Institute of Mental Health discovered that, in some children who had an abrupt onset of obsessive-compulsive dis-orders or Tourette’s syndrome, their problems appeared soon after an infection with group A streptococcus. Some doctors suspect antibodies a child makes against a strep infection may attack healthy cells in the part of the brain that controls motor movements. But Dr. Roger Kurlan, a neurologist at the University of Rochester’s Strong Memorial Hospital, says strep infections are so common, it’s rare for a child never to have had at least one. Kurlan, co-author of the Pediatrics report, said in a statement that tics "wax and wane. "Often times patients come in to the doctor’s office soon after their symptoms have peaked, so it proves nothing to show that a child’s symptoms subsided after they saw a doctor and were treated with antibiotics. It’s quite possible that doctors could give such children a green-bean diet and the children would get better." In rare cases, streptococcal infections can cause rheumatic fever — inflammation of the heart and joints — as well as kidney damage. Casey reviewed the medical literature, pulling together studies involving children aged six months to 18 that compared a number of different cephalosporins against penicillin. Overall, she found the newer drugs had a far better "bacterial cure rate." One theory is that other bacteria that live in the mouth and tonsils produce an enzyme that breaks down penicillin, so it becomes ineffective, and that humans may have more of these enzyme-producing organisms than we used to. The World Health Organization and other groups recommend penicillin, or its related cousin, amoxicillin, known by children as the "banana medicine" because of its flavour, as the front-line treatment for strep throat. "Cephalosporins may very well be more effective therapy and should be included in the guideline recommendations," Casey says. "They should be considered an option for first-line treatment." The drugs can cost about four times as much as penicillin for a 10-day course of treatment. But older, "first-generation" cephalosporins cost about the same as penicillin. Ottawa community pediatrician Dr. Fionnuala O’Kelly says most kids with strep throat do well on penicillin. She also warns group A strep constantly changes. "If we all suddenly jumped on the bandwagon and said, ‘OK, forget amoxicillin, forget penicillin, everyone is going to go on cephalosporins,’ it could be that in a number of years cephalosporins would stop being as effective as they are now in eradicating the carrier state or getting rid of the infection the first time around."
