Skip to main content
NCBI home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
letter
. 1981 Oct;73(10):943–948.

Group B Streptococcal Pharyngitis in the Compromised Adult: Therapeutic Considerations

Michael L Corrado, Donald J Palmadessa, Sandra H Corrado, Charles Weissman, Charles E Cherubin, Sheldon H Landesman
PMCID: PMC2552703  PMID: 7310910

Abstract

Group B streptococci (GBS) have been infrequently recognized as a cause of pharyngitis. We report three cases of GBS pharyngitis in patients with underlying diseases, two of whom were treated with and responded incompletely to oral beta-lactam antibiotics. The susceptibility of 20 clinical isolates of GBS was tested by a broth dilution method to six antibiotics which could conceivably be used in the therapy of GBS pharyngitis. Penicillin G, clindamycin, and erythromycin were most active with mean minimal inhibitory concentrations (MIC) of 0.06 μg/ml or less. Rifampin and cefaclor were least active with mean MICs of 0.71 ug/ml or more. Ampicillin was intermediate in its activity. Therapy traditionally used for Group A streptococcal (GAS) pharyngitis may, at times, be suboptimal for GBS pharyngitis in compromised patients. This may be due to higher minimal bactericidal concentrations (MBC) of GBS than GAS, to inadequate penetration of penicillins into pharyngeal tissues or to host factors. It is suggested that GBS can cause pharyngitis in adults, particularly the compromised patient, and that in cases where there is a poor response to penicillin or ampicillin therapy, alternative drugs (erythromycin or clindamycin) may be used.

Full text

PDF
943

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Armstrong D., Blevins A., Louria D. B., Henkel J. S., Moody M. D., Sukany M. Groups B, C, and G streptococcal infections in a cancer hospital. Ann N Y Acad Sci. 1970 Oct 30;174(2):511–522. doi: 10.1111/j.1749-6632.1970.tb45577.x. [DOI] [PubMed] [Google Scholar]
  2. Backmann H., Drees H., Geisen D., Mündnich K., Ritzerfeld W. Penicillin-V-Kalium in Tonsillengewebe und Serum. MMW Munch Med Wochenschr. 1975 Sep 5;117(36):1405–1408. [PubMed] [Google Scholar]
  3. Bayer A. S., Chow A. W., Anthony B. F., Guze L. B. Serious infections in adults due to group B streptococci. Clinical and serotypic characterization. Am J Med. 1976 Oct;61(4):498–503. doi: 10.1016/0002-9343(76)90329-6. [DOI] [PubMed] [Google Scholar]
  4. Chretien J. H., McGinniss C. G., Thompson J., Delaha E., Garagusi V. F. Group B beta-hemolytic streptococci causing pharyngitis. J Clin Microbiol. 1979 Sep;10(3):263–266. doi: 10.1128/jcm.10.3.263-266.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Darling C. L. Standardization and evaluation of the CAMP reaction for the prompt, presumptive identification of Streptococcus agalactiae (Lancefield group B) in clinical material. J Clin Microbiol. 1975 Feb;1(2):171–174. doi: 10.1128/jcm.1.2.171-174.1975. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Devine L. F., Johnson D. P., Rhode S. L., 3rd, Hagerman C. R., Pierce W. E., Peckinpaugh R. O. Rifampin: effect of two-day treatment on the meningococcal carrier state and the relationship to the levels of drug in sera and saliva. Am J Med Sci. 1971 Feb;261(2):79–83. doi: 10.1097/00000441-197102000-00004. [DOI] [PubMed] [Google Scholar]
  7. Doern G. V., Siebers K. G., Hallick L. M., Morse S. A. Antibiotic susceptibility of beta-lactamase-producing strains of Branhamella (Neisseria) catarrhalis. Antimicrob Agents Chemother. 1980 Jan;17(1):24–29. doi: 10.1128/aac.17.1.24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dowd J. M., Blink D., Miller C. H., Frank P. F., Pierce W. E. Antibiotic prophylaxis of carriers of sulfadiazine-resistant meningococci. J Infect Dis. 1966 Oct;116(4):473–480. doi: 10.1093/infdis/116.4.473. [DOI] [PubMed] [Google Scholar]
  9. EICKHOFF T. C., KLEIN J. O., DALY A. K., INGALL D., FINLAND M. NEONATAL SEPSIS AND OTHER INFECTIONS DUE TO GROUP B BETA-HEMOLYTIC STREPTOCOCCI. N Engl J Med. 1964 Dec 10;271:1221–1228. doi: 10.1056/NEJM196412102712401. [DOI] [PubMed] [Google Scholar]
  10. Ericsson H. M., Sherris J. C. Antibiotic sensitivity testing. Report of an international collaborative study. Acta Pathol Microbiol Scand B Microbiol Immunol. 1971;217(Suppl):1+–1+. [PubMed] [Google Scholar]
  11. HAFEZ F. F., STEWART S. M., BURNET M. E. PENICILLIN LEVELS IN SPUTUM. Thorax. 1965 May;20:219–225. doi: 10.1136/thx.20.3.219. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Howard J. B., McCracken G. H., Jr The spectrum of group B streptococcal infections in infancy. Am J Dis Child. 1974 Dec;128(6):815–818. doi: 10.1001/archpedi.1974.02110310063011. [DOI] [PubMed] [Google Scholar]
  13. Lerner P. I., Gopalakrishna K. V., Wolinsky E., McHenry M. C., Tan J. S., Rosenthal M. Group B streptococcus (S. agalactiae) bacteremia in adults: analysis of 32 cases and review of the literature. Medicine (Baltimore) 1977 Nov;56(6):457–473. doi: 10.1097/00005792-197711000-00001. [DOI] [PubMed] [Google Scholar]
  14. MANNIK M., BARINGER J. R., STOKES J., 3rd Infections due to group B beta-hemolytic streptococci. Report of three cases and review of the literature. N Engl J Med. 1962 May 3;266:910–913. doi: 10.1056/NEJM196205032661803. [DOI] [PubMed] [Google Scholar]
  15. Palmer D. W. Inadequate response to "adequate" treatment of bacterial infection: L forms and "bactericidal" antibiotic activity. J Infect Dis. 1979 Jun;139(6):725–727. doi: 10.1093/infdis/139.6.725. [DOI] [PubMed] [Google Scholar]
  16. Panzer J. D., Brown D. C., Epstein W. L., Lipson R. L., Mahaffey H. W., Atkinson W. H. Clindamycin levels in various body tissues and fluids. J Clin Pharmacol New Drugs. 1972 Jul;12(7):259–262. doi: 10.1002/j.1552-4604.1972.tb00052.x. [DOI] [PubMed] [Google Scholar]
  17. Quayle A. A., Whitmarsh V. B. Mixed salivary levels of clindamycin following single dose oral administration. Br J Oral Surg. 1972 Jul;10(1):24–29. doi: 10.1016/s0007-117x(72)80005-2. [DOI] [PubMed] [Google Scholar]
  18. RANTZ L. A., RANDALL E. Use of autoclaved extracts of hemolytic streptococci for serological grouping. Stanford Med Bull. 1955 May;13(2):290–291. [PubMed] [Google Scholar]
  19. Stewart S. M., Fisher M., Young J. E., Lutz W. Ampicillin levels in sputum, serum, and saliva. Thorax. 1970 May;25(3):304–311. doi: 10.1136/thx.25.3.304. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Summary of the workshop on perinatal infections due to group B Streptococcus. J Infect Dis. 1977 Jul;136(1):137–152. doi: 10.1093/infdis/136.1.137. [DOI] [PubMed] [Google Scholar]
  21. Wilkinson H. W. Group B streptococcal infection in humans. Annu Rev Microbiol. 1978;32:41–57. doi: 10.1146/annurev.mi.32.100178.000353. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES