Tags: Streptococcal pharyngitis

Streptococcus Pyogenes

Streptococcus pyogenes is a human pathogen without an animal reservoir. Group A streptococci (GAS) cause most streptococcal disease, but other groups are important pathogens in some settings (Box 1). Group A streptococcal infections have the highest incidence in children younger than age 10. The asymptomatic prevalence is also higher (15-20%) in children, compared with that in adults (<5%).

Streptococcal Toxic Shock Syndrome

In the late 1980s, invasive GAS infections occurred in North America and Europe in previously healthy individuals of all ages. This illness is associated with bacteremia, deep soft-tissue infection, shock, multi-organ failure, and death in 30% of cases. StrepTSS occurs sporadically, although minor epidemics have been reported. Most patients present with a viral-like prodrome, history of minor trauma, recent surgery, or varicella infection.

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In 3995 patients who took azithromycin 1.5 g in divided doses over 5 days or who took 1 g as a single dose for urethritis/cervicitis adverse events occurred in 12%. In patients over 65 years the rate was 9.3%, and in children under 14 years of age it was 5.4%.

Respiratory Tract Infections, Upper

The goals of treatment include reduction in signs and symptoms, eradication of infection, and prevention of complications. Avoidance of unnecessary antibiotic use is another goal in view of S. pneumonia. dClindamycin is only recommended in cases of documented S. pneumoniae. It is not effective against H. influenzae or M. catarrhalis.

Toxicity of Antimicrobial Therapy

The mechanisms associated with common adverse reactions to antimicrobials include dose-related toxicity that occurs in a certain fraction of patients when a critical plasma concentration or total dose is exceeded, and toxicity that is unpredictable and mediated through allergic or idiosyncratic mechanisms. For example, certain classes of drugs such as the aminoglycosides are associated with dose-related toxicity.

Management of Sepsis

Sepsis, sepsis syndrome, septic shock, and multiorgan dysfunction are all part of a continuum of infection-related systemic illness. Table Definitions for Sepsis, Sepsis Syndrome, Septic Shock and Multiorgan Dysfunction Syndrome gives definitions for each of these entities. The pathogenesis of sepsis is very complex, involving a large number of mediators.

Penicillins

Penicillin G is an acid that is combined with sodium, potassium, procaine, or benzathine to increase its stability or to regulate its absorption. The latter two are “long-acting” forms. Penicillin G is useful in the treatment of streptococcal infections due to S. pyogenes (group A), S. agalactiae (group B), S. pneumoniae, viridans streptococci, Corynebacterium diphtheria, N. meningitidis, many strains of N. gonorrhea, Treponema pallidum, and many anaerobic streptococci, such as peptococcus and peptostreptococcus.

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Clindamycin generally is used for the treatment of serious infections caused by susceptible gram-positive bacteria and for the treatment of serious infections caused by susceptible anaerobic bacteria. Because the risk of severe, potentially fatal Clostridium difficile-associated diarrhea and colitis may be higher with clindamycin than with certain other anti-infectives, use of the drug should be limited to serious infections for which less toxic and/or more effective anti-infectives are not readily available. However, it should be noted that C. difficile diarrhea and colitis has been associated with the use of nearly all anti-infectives, being reported most frequently with clindamycin, cephalosporins, and ampicillin; second and third generation cephalosporins play an increasingly important role.

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Amoxicillin and clavulanate potassium is used orally for the treatment of lower respiratory tract infections, otitis media, sinusitis, skin and skin structure infections, and urinary tract infections caused by susceptible organisms. Amoxicillin and clavulanate potassium also has been used orally for the treatment of chancroid and gonorrhea caused by susceptible organisms. Amoxicillin and clavulanate potassium has been effective when used orally in adults and children for the treatment of abscesses, cellulitis, and impetigo caused by susceptible penicillinase-producing and nonpenicillinase-producing Staphylococcus aureus and S. epidermidis, Streptococcus pyogenes (group A b-hemolytic streptococci), or Corynebacterium. Results of several controlled studies indicate that amoxicillin and clavulanate potassium is as effective as cefaclor in the treatment of these infections.

Penicillin V, Penicillin V Potassium

Penicillin V potassium is used for the treatment of mild to moderately severe infections caused by organisms susceptible to low concentrations of the drug or for prophylaxis of certain streptococcal infections. For specific information on the uses of penicillin V potassium, see Uses in the Natural Penicillins General Statement 8:12.16.04.