Brook Itzhak
Department of Pediatrics / Medicine, Georgetown University, Washington, District of Columbia, United States.
Int Arch Otorhinolaryngol. 2017 Jul;21(3):286-296. doi: 10.1055/s-0036-1584294. Epub 2016 Jun 3.
Despite its in vitro efficacy, penicillin often fails to eradicate Group A β-hemolytic streptococci (GABHS) from patients with acute and relapsing pharyngo-tonsillitis (PT). This review of the literature details the causes of penicillin failure to eradicate GABHS PT and the therapeutic modalities to reduce and overcome antimicrobial failure. The causes of penicillin failure in eradicating GABHS PT include the presence of β lactamase producing bacteria (BLPB) that "protect" GABHS from any penicillin; the absence of bacteria that interfere with the growth of GABHS; co-aggregation between GABHS and Moraxella catarrhalis; and the poor penetration of penicillin into the tonsillar tissues and the tonsillo-pharyngeal cells, which allows intracellular GABHS and Staphylococcus aureus to survive. The inadequate intracellular penetration of penicillin can allow intracellular GABHS and S. aureus to persist. In the treatment of acute tonsillitis, the use of cephalosporin can overcome these interactions by eradicating aerobic BLPB (including M. catarrhalis), while preserving the potentially interfering organisms and eliminating GABHS. In treatment of recurrent and chronic PT, the administration of clindamycin, or amoxicillin-clavulanic acid, can eradicate both aerobic and anaerobic BLPB, as well as GABHS. The superior intracellular penetration of cephalosporin and clindamycin also enhances their efficacy against intracellular GABHS and S. aureus.
尽管青霉素在体外具有疗效，但在治疗急性和复发性咽扁桃体炎（PT）患者时，它常常无法根除A组β溶血性链球菌（GABHS）。本文献综述详细阐述了青霉素无法根除GABHS性PT的原因以及减少和克服抗菌治疗失败的治疗方式。青霉素无法根除GABHS性PT的原因包括存在产生β内酰胺酶的细菌（BLPB），这些细菌“保护”GABHS免受任何青霉素的作用；缺乏干扰GABHS生长的细菌；GABHS与卡他莫拉菌之间的共聚集；以及青霉素对扁桃体组织和扁桃体 - 咽细胞的渗透性差，这使得细胞内的GABHS和金黄色葡萄球菌得以存活。青霉素细胞内渗透性不足会使细胞内的GABHS和金黄色葡萄球菌持续存在。在治疗急性扁桃体炎时，使用头孢菌素可以通过根除需氧BLPB（包括卡他莫拉菌）来克服这些相互作用，同时保留可能具有干扰作用的微生物并消除GABHS。在治疗复发性和慢性PT时，给予克林霉素或阿莫西林 - 克拉维酸可以根除需氧和厌氧BLPB以及GABHS。头孢菌素和克林霉素优越的细胞内渗透性也增强了它们对细胞内GABHS和金黄色葡萄球菌的疗效。
