Dan Olson1, M Bruce Edmonson. 1. Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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.
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.
Authors: Marta Torres-Narbona; María Del Carmen Morillas Escobar; Loreto Mariscal de Gante Sánchez Journal: Aten Primaria Date: 2018-10-26 Impact factor: 1.137
Authors: Renato Gualtieri; Gabriel Bronz; Mario G Bianchetti; Sebastiano A G Lava; Elena Giuliano; Gregorio P Milani; Luca M M Jermini Journal: Eur J Pediatr Date: 2021-02-02 Impact factor: 3.183