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Coming Soon: Antibiotic-Resistant Strep?

4/19/2002      

FRIDAY, April 19 (HealthScoutNews) -- In the wake of a new report that the strep throat germ is now showing significant antibiotic resistance in the United States, many people are wondering if they -- or their children -- are at risk.

They just might be, unless all of us reduce our dependence on antibiotics, says Philip Tierno, director of clinical microbiology at New York University Medical Center and Mt. Sinai Medical Center in New York City.

"Antibiotic resistance is more prevalent than you'd think," Tierno adds. There are two main reasons for it: Overprescription of antibiotics by doctors and the use of antibiotics in livestock, he says.

"One hundred and fifty million prescriptions are written annually," Tierno says. "Ninety million of those are for antibiotics, and 50 million of those are unnecessary."

Many antibiotic prescriptions are written for sore throats, but only a small percentage of them are caused by Group A streptococci bacteria, which causes strep throat. The germ can also cause sinus, ear and skin infections.

Left untreated, strep can progress into scarlet fever or the more serious rheumatic fever, with potentially fatal consequences. Young children are especially vulnerable to such complications.

Strep throat is commonly treated with antibiotics, such as penicillin, or erythromycin for those who are allergic to penicillin.

In yesterday's New England Journal of Medicine report, researchers from Children's Hospital of Pittsburgh studied a group of 100 area school children from kindergarten through eighth grade. They found that Group A streptococci was resistant to erythromycin in 48 percent of the throat cultures taken between October 2000 and May 2001.

According to the researchers, this is the first time such a high level of resistance to erythromycin has been found in the United States.

Similarly high levels of resistance have been reported in other countries, however, Tierno says. In Japan and Finland, he says, resistance to Group A strep has been reported at levels exceeding 50 percent.

The good news, according to Tierno, is that in Japan the rate of resistance has fallen as health officials there decreased their use of erythromycin-based antibiotics. By not using these drugs, Tierno explains, the germs become vulnerable to them again.

The Pittsburgh researchers followed the children for three years, and during the first two years, while they did find cases of strep, they found no signs of antibiotic resistance. It wasn't until the third year that the antibiotic-resistant strain appeared.

Tierno says this finding clearly points to overuse of antibiotics.

"What causes drug resistance is the inappropriate use of antibiotics by physicians," he says. But patients are partly to blame as well, he adds, because they push for inappropriate prescriptions when they're ill.

Dr. James Musser is chief of the Laboratory of Human Bacterial Pathogenesis at the National Institute of Allergy and Infectious Diseases in Hamilton, Mont. He says, "From a national perspective, we need to be very concerned about increasing antibiotic resistance in any pathogen."

And, he adds, we need a study that looks at a greater geographical area to assess how widespread the problem [uncovered in Pittsburgh] might be.

In the meantime, he says, "It's important for patients to realize that not every upper-respiratory infection is of bacterial origin and to listen closely to the advice of the treating physician."

That means patients shouldn't badger their doctor for antibiotics unless they're deemed necessary.

What to Do: For more information on strep throat infections, visit Kid's Health. To learn more about the problem of antibiotic resistance, read this information from the U.S. Centers for Disease Control and Prevention.

SOURCES: Philip Tierno, Ph.D., director, clinical microbiology, New York University Medical Center, Mt. Sinai Medical Center, New York City; James Musser, M.D., Ph.D., chief, Laboratory of Human Bacterial Pathogenesis, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Mont.; April 18, 2002, New England Journal of Medicine

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