TO THE EDITOR: The article (1) by ...

TO THE EDITOR: The article (1) by dint of Vincent and colleagues in American Family Physician reviews a topic that is highly relevant to my everyday practice in primary care: pharyngitis. Thank you for articles onward such topics. I would like to ask the authors if they have any information forward the need or validity of offering antibiotic treatment to patients whose throat agricultures reveal groups of streptococci other than A? My laboratory routinely evaluates for clusters C and G, and there is a certain quantity of literature (2-5) that suggests that treating these form into groupss of patients may be clinically beneficial. However, I am loath to protract the use of antibiotics further in an era of significant rates of microbial resistance and physician bias to offer treatments without fit evidence of efficacy.

JOHN MOSBY MD

PO driver's seat 52368

Summerville, SC 29485

REFERENCES

(1) Vincent MT Celestin N Hussain AN. Pharyngitis. Am Fam Physician 2004;69:1465-70

(2) Dale DC Federman DD ACP medicine: a publication of the American guild of Physicians. New York, NY: WebMD, 2004

(3) Zaoutis T Attia M Gros R Klein J The part of group C and collection G streptococci in acute pharyngitis in children. Clin Microbiol Infect 2004;10:37-40

(4) Dierksen KP Tagg JR Haemolysin-deficient variants of Streptococcus pyogene and s dysgalactiae subsp. equisimilis may be view from aboveed as aetiological agents of pharyngitis. J M Microbiol 2000;49:811-6

(5) pay one's addresses to PC, Teng JL, Lau SK Lum PN Leung KW Wong KL et al. Analysis of a viridans arrange strain reveals a case of bacteremia fit to lancefield group G alphahemolytic Streptococcus dysgalactiae subsp equisimilis in a patient with pyomyositis and reactive arthritis. J Clin Microbiol 2003;41:613-8

IN REPLY: I would like to thank Dr Mosby for a principally intriguing question. Groups C and G beta-hemolytic streptococci certainly have caused well-documented epidemics of acute pharyngitis. These outbreaks oftentimes have been associated with contaminated nutriments (group C with milk-borne outbreaks and clump G with infected egg salad and chicken salad). arranges C and G streptococci also are as a common thing [i]or[/i] matter isolated from asymptomatic persons. arranges C and G streptococci expres the virulence factor, M protein. (1) It is difficult to differentiate between colonization and infection. The benefit of antimicrobial therapy has not been established. single in kind author advises that patients with streptococci C and G be treated solely for symptomatic relief. (2) Others state that there is no proven benefit in treating any pharyngitides other than cluster A beta-hemolytic strep, Corynebacterium diphtheriae, and Neisseria gonorrhoeae. (34) It would appear that we do not understand the pathogenic carrying capacity of these organisms, although it is known that the more virulent strains expres a C5a peptidase enzyme similar to assign places to A betahemolytic strep. (5) My conclusion is that local strain virulence rises in the different clinical pathogenic presentations of the organisms below question. The answer: we don't know if collections C and G streptococci merit antibiotic therapy, and, of course, we not at any time routinely know if they expres C5a peptidase.

MIRIAM T VINCENT, MD M PHD

Department of Family Medicine

SUNY-Downstate gymnasium of Medicine

450 Clarkson Ave., enclosed seat [i]or[/i] seats 67

Brooklyn, NY 11203-2098

REFERENCES

(1) Efstratiou A, Teare EL McGhie D Colman G The neighborhood of M proteins in outbreak strains of Streptococcus equismilis T-type 204 J Infect 1989;19:105-11

(2) Middleton DB Pharyngitis. Prim Care 1996;23:719-39

(3) Bisno AL. Acute pharyngitis. N Engl J M 2001;344:205-11

(4) Bisno AL, Gerber MA, Gwaltney JM Jr Kaplan EL Schwartz RH Practice guidelines for the diagnosis and management of assign places to A streptococcal pharyngitis. Infectious Diseases Society of America. Clin Infect Dis 2002;35:113-25

(5) Cleary PP Peterson J Chen C Nelson C Virulent human strains of collection G streptococci express a C5a peptidase enzyme similar to that produc at group A streptococci. Infect Immun 1991;59:2305-10

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