RIFAMPIN TREATMENT FOR GROUP A STREPTOCOCCAL CARRIERS

Abstract

Chronic pharyngeal carriage of group A streptococci (GAS) is of concern to many physicians and families. No therapy has proved effective in eliminating GAS from asymptomatic patients with positive cultures after penicillin (P). Rifampin (Rif) has excellent in vitro activity against GAS. Because Rif effectively terminates meningococcal and H. influenzae carriage, we evaluated Rif for GAS carriage. Otherwise healthy children 2 to 16 y.o. were defined as carriers when a throat culture 3 weeks after IM benzathine P (600,000 u ≤60 lbs., 1.2 million u >60 lbs.) for GAS pharyngitis showed persistence of the same GAS serotype. Thirty-seven carriers were randomly assigned to 3 groups: Group I (13 patients): no treatment; Group II (10): repeat IM benzathine P; Group III (14): repeat IM benzathine P and oral Rif (10 mg/kg BID × 8 doses). Groups were comparable in age, sex, and socio-economic status. Cultures were obtained every 3 weeks for at least 9 weeks. Group II and III patients culture-positive 3 weeks after treatment were crossed to the opposite group. At 3 weeks, 10/13 (77%) in Group I, 7/10 (70%) in Group II, but only 1/14 (7%) in Group III were GAS-positive. Group III differs from Group I (p< 0.001) and from Group II (p<0.01). In the cross-over phase, 4/4 treated Group II patients were negative after P + Rif. Overall, P + Rif was successful in 17/18 courses, differing from Groups I and II (each p<0.005). These data show oral Rifampin plus IM penicillin to be effective in eradicating chronic group A streptococcal carriage.

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