Brook I
Department of Pediatrics, Georgetown University School of Medicine, Washington, DC.
J Fam Pract. 1994 Feb;38(2):175-9.
Recurrent group A beta-hemolytic streptococcus (GABHS) pharyngotonsillitis related to penicillin failure presents a serious clinical problem. Failure to eradicate streptococci from patients can occasionally lead to rheumatic fever and rarely to glomerulonephritis. beta-lactamase-producing strains of aerobic and anaerobic bacteria in inflamed tonsils have been associated with increased failure rates of penicillins in the eradication of these infections. These organisms include Staphylococcus aureus, Haemophilus influenzae and H parainfluenzae, Moraxella catarrhalis, Fusobacterium sp, and pigmented Prevotella and Porphyromonas spp. The indirect pathogenicity of these organisms is apparent in their ability not only to survive penicillin therapy but also to protect penicillin-susceptible pathogens from that drug. These organisms have demonstrated the ability to protect GABHS in vitro and in vivo from penicillin. Numerous reports have described the successful therapy of recurrent GABHS tonsillitis with antimicrobials directed at both GABHS and the beta-lactamase-producing organisms.
与青霉素治疗失败相关的复发性A组β溶血性链球菌（GABHS）咽扁桃体炎是一个严重的临床问题。未能从患者体内根除链球菌偶尔会导致风湿热，很少会导致肾小球肾炎。发炎扁桃体中产生β-内酰胺酶的需氧菌和厌氧菌与青霉素根除这些感染的失败率增加有关。这些微生物包括金黄色葡萄球菌、流感嗜血杆菌和副流感嗜血杆菌、卡他莫拉菌、梭杆菌属以及产色素的普雷沃菌属和卟啉单胞菌属。这些微生物的间接致病性不仅体现在它们能够在青霉素治疗中存活，还体现在它们能够保护对青霉素敏感的病原体免受该药物的影响。这些微生物已证明在体外和体内都有保护GABHS免受青霉素影响的能力。许多报告描述了用针对GABHS和产生β-内酰胺酶的微生物的抗菌药物成功治疗复发性GABHS扁桃体炎的情况。
