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Children’s Hospital of Pittsburgh Researchers Find High Frequency of Erythromycin Resistance in School Children with Strep Throat

Researchers at Children’s Hospital of Pittsburgh have identified a high frequency of erythromycin resistance among Group A streptococci (GAS) recovered from elementary school children in Pittsburgh. GAS are the cause of “strep throat.”

The study’s first author and principal investigator, Judith Martin, MD, said, “With this new information, we are recommending that macrolide antibiotics [the class of drugs to which erythromycin belongs] be withheld from routine use in the treatment of strep throat until more information is available.”

Study results were published in this week’s issue of the New England Journal of Medicine.

“Strep throat occurs most commonly from October to April in children 5 to 15 years old,” said Dr. Martin. “For those children who visit a doctor because of a sore throat, 15 to 20 percent will be caused by GAS.” While many antibiotics are effective in the treatment of strep throat, penicillin V and amoxicillin are the drugs of choice. Erythromycin, however, is usually recommended for those who are allergic to penicillin or amoxicillin.

These findings were uncovered through an ongoing study of streptococcal infections among children attending an elementary school in Pittsburgh. Specifically, 1,794 throat cultures were performed on 100 children between September 2000 and May 2001. Three hundred and eighteen throat cultures from 60 of the 100 children were positive for GAS. Forty-eight percent of the bacteria tested were resistant to erythromycin. In addition, 100 isolates from the local community also were tested in the spring of 2001 and 38 percent were resistant to erythromycin.

“Antibiotic resistance in Group A streptococcus has been reported previously in areas of Europe and Japan, however, before this report, it had not been documented to this degree in the United States,” Dr. Martin stated. The initial detection of erythromycin resistance occurred after the winter holiday vacation suggesting possible acquisition of the strain outside of school. Very rapid spread of the bacteria in the school population suggests that it may be discovered in other communities.

This study was supported by the National Institutes of Health, Children’s Hospital of Pittsburgh’s General Clinical Research Center and the Research Advisory Committee, the University of Pittsburgh and the American Heart Association Pennsylvania-Delaware Affiliate.

Melanie Tush Finnigan, 412-692-5016,

Last Update
February 20, 2008
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Last Update
February 20, 2008