Outcomes in children treated for perineal group A beta-hemolytic streptococcal dermatitis.
Pediatr Infect Dis J
; 30(11): 933-6, 2011 Nov.
Article
em En
| MEDLINE
| ID: mdl-21747323
ABSTRACT
OBJECTIVES:
To evaluate reports that describe relapse or recurrence following treatment of perineal streptococcal dermatitis (PSD), we studied a large cohort of children with these perianal or perivaginal infections to determine whether outcomes are related to the antimicrobial agent selected for initial treatment.METHODS:
We audited laboratory logs and medical records to retrospectively identify incident cases of culture-confirmed PSD in children at a large university-affiliated health system during 2006-2008. We estimated rates of recurrence (defined as any return visit with a clinical diagnosis of perineal dermatitis within 6 months) and, then, incorporated these rates into a meta-analysis that included 8 previous studies.RESULTS:
A total of 81 children had incident PSD during the study period, and 26 (32.1%) had a recurrence. Most (18/26 [69.2%]) had their first recurrence within 6 weeks. Among children treated with an oral agent, the recurrence rate was 16/42 (38.1%) following penicillin or amoxicillin and 10/36 (27.8%) following a beta-lactamase resistant agent (adjusted odds ratio 2.02 [95% confidence interval {CI} 0.69-5.92]). In the meta-analysis, recurrence rates following penicillin or amoxicillin were consistent across studies (fixed-effect test for heterogeneity, P = 0.35), and the pooled rate (37.4% [95% CI 28.8%-46.5%]) was higher than observed following a beta-lactamase resistant agent (odds ratio 2.39 [95% CI 1.18-4.81]).CONCLUSIONS:
Perineal streptococcal dermatitis initially treated with penicillin or amoxicillin is consistently associated with a high risk of clinical recurrence. Whether treatment with a beta-lactamase resistant agent reduces this risk is uncertain and should be subjected to a clinical trial.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Canal Anal
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Pênis
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Infecções Estreptocócicas
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Streptococcus
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Vagina
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Dermatite
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Antibacterianos
Idioma:
En
Ano de publicação:
2011
Tipo de documento:
Article