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American Academy of Pediatrics
Case Report

Macrolide Treatment Failure in Streptococcal Pharyngitis Resulting in Acute Rheumatic Fever

Latania K. Logan, James B. McAuley and Stanford T. Shulman
Pediatrics March 2012, 129 (3) e798-e802; DOI: https://doi.org/10.1542/peds.2011-1198
Latania K. Logan
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James B. McAuley
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Stanford T. Shulman
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Abstract

Macrolide resistance (MR) in group A Streptococcus (GAS) has been well documented in several countries and has become clinically significant since the large increases in macrolide usage during the 1970s. Macrolides are recommended as an alternative therapy for GAS pharyngitis, the most common cause of bacterial pharyngitis. Macrolide resistance has been associated with certain emm types, a sequence-based typing system of the hypervariable region of the GAS M-protein gene. Clinical failure of macrolide treatment of GAS infections can be associated with complications including acute rheumatic fever and rheumatic heart disease, the leading cause of acquired heart disease in children worldwide. Here we report 2 pediatric cases of MR and/or treatment failure in the treatment of GAS pharyngitis with the subsequent development of acute rheumatic fever. We also review the literature on worldwide MR rates, molecular classifications, and emm types, primarily associated with GAS pharyngeal isolates between the years of 2000 and 2010. The use of macrolides in the management of GAS pharyngitis should be limited to patients with significant penicillin allergy.

KEY WORDS
  • macrolides
  • anti-bacterial agents
  • child
  • pediatrics
  • Streptococcus pyogenes
  • streptococcal infections
  • pharyngitis
  • drug resistance
  • bacterial drug resistance
  • rheumatic fever
  • phenotype
  • genotype
  • bacterial antigens
  • Abbreviations:
    ARF —
    acute rheumatic fever
    GAS —
    group A streptococcus
    MLS —
    macrolide-lincosamide-streptogramin antibiotics
    MR —
    macrolide resistance
    RADT —
    rapid antigen-detection test
    RHD —
    rheumatic heart disease
    • Accepted October 25, 2011.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 129, Issue 3
    1 Mar 2012
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    Macrolide Treatment Failure in Streptococcal Pharyngitis Resulting in Acute Rheumatic Fever
    Latania K. Logan, James B. McAuley, Stanford T. Shulman
    Pediatrics Mar 2012, 129 (3) e798-e802; DOI: 10.1542/peds.2011-1198

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    Macrolide Treatment Failure in Streptococcal Pharyngitis Resulting in Acute Rheumatic Fever
    Latania K. Logan, James B. McAuley, Stanford T. Shulman
    Pediatrics Mar 2012, 129 (3) e798-e802; DOI: 10.1542/peds.2011-1198
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