Dykhuizen R S, Golder D, Reid T M, Gould I M
Infection Unit, Aberdeen Royal Infirmary NHS Trust, Forresterhill, UK.
J Antimicrob Chemother. 1996 Jan;37(1):133-8. doi: 10.1093/jac/37.1.133.
One hundred and sixty-five consecutive patients ( > 2 years of age) with acute group A streptococcal (GAS) pharyngitis randomly received co-amoxyclav (79 patients) or phenoxymethyl penicillin (86 patients). beta-Lactamase activity in saliva was determined for each patient. At follow up after seven days, tonsillar cultures from seven patients (9.6%) in the penicillin V group grew group A streptococcus; three of these patients had tonsillitis clinically. In the co-amoxiclav group these figures were three (3.8%) and two respectively (P > 0.05). Within the 12 month follow up period, there were four clinical recurrences (6.1%) in the penicillin V group and seven (9.3%) in the co-amoxiclav group (P > 0.1). beta-Lactamase activity in the saliva was demonstrated in 29 patients (19.2%). Fourteen (74%) of 19 bacteriological failures or clinical recurrences had beta-lactamase activity, versus 15 (12%) of 129 successfully treated patients (P < 0.001). There is no evidence that oral co-amoxiclav is better than oral penicillin V for the first treatment of acute GAS pharyngitis, but bacteriological failure and clinical recurrence are strongly associated with the presence of beta-lactamase activity in commensal flora.
165例年龄大于2岁的急性A组链球菌（GAS）咽炎患者连续入选并随机接受阿莫西林克拉维酸（79例）或青霉素V（86例）治疗。测定每位患者唾液中的β-内酰胺酶活性。在7天的随访中，青霉素V组7例患者（9.6%）的扁桃体培养物中培养出A组链球菌；其中3例患者临床上有扁桃体炎。在阿莫西林克拉维酸组，这些数字分别为3例（3.8%）和2例（P>0.05）。在12个月的随访期内，青霉素V组有4例临床复发（6.1%），阿莫西林克拉维酸组有7例（9.3%）（P>0.1）。29例患者（19.2%）唾液中显示有β-内酰胺酶活性。19例细菌学治疗失败或临床复发患者中有14例（74%）有β-内酰胺酶活性，而129例成功治疗患者中有15例（12%）有β-内酰胺酶活性（P<0.001）。没有证据表明口服阿莫西林克拉维酸在急性GAS咽炎的初始治疗中比口服青霉素V更好，但细菌学治疗失败和临床复发与共生菌群中β-内酰胺酶活性的存在密切相关。
