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Peptostreptococcus Infection - detailed stuff


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Is this the same thing as the strep that our kid get, or are there different kinds of strep infections?

 

http://emedicine.medscape.com/article/225140-overview

http://emedicine.medscape.com/article/225140-clinical

http://emedicine.medscape.com/article/225140-workup

http://emedicine.medscape.com/article/225140-treatment

http://emedicine.medscape.com/article/225140-medication

http://emedicine.medscape.com/article/225140-medication#2

http://emedicine.medscape.com/article/225140-followup

 

It says that it is best to get a culture from aspirating it with a needle, like in the case of a sinus thing. How many doctors do that?

 

Here is what they wrote:

 

Direct-needle aspiration is the best method of obtaining a culture. Direct-needle aspiration is probably the best method of obtaining a culture, and the use of swabs is much less desirable. Specimens obtained from normally sterile sites, such as blood, spinal, joint, or peritoneal fluids, are collected after thorough skin decontamination. Two approaches are used to culture the maxillary sinus by aspiration following sterilization of the canine fossa or the nasal vestibule, either via the canine fossa or via the inferior meatus.

 

It also says that there are a number of medications that can get to this infection, including clavulanate (augmentin), but it doesn't mention azithromycin. I wonder if anyone has information about that???? Here is a direct quote:

 

Because peptostreptococci are often mixed with other aerobic and anaerobic bacteria in the infectious process, broader antimicrobial coverage is often necessary. Furthermore, because of the difficulty in recovering other fastidious anaerobic organisms, they may not be recovered even when cultures are taken.

 

Antimicrobial agents with broader coverage against anaerobic bacteria, including peptostreptococci, include cefoxitin, clindamycin, carbapenem (eg, imipenem, meropenem, ertapenem, doripenem), tigecycline, the combination of a penicillin (eg, ticarcillin) with a beta-lactamase inhibitor (ie, clavulanate), and quinolones with anti-anaerobic activity (ie, moxifloxacin).[26]

 

An anti–gram-negative enteric agent is generally added to treat Enterobacteriaceae when treating intra-abdominal infections.

 

Metronidazole has excellent activity against gram negative anaerobic bacteria and has no activity against aerobic and facultative bacteria. Gram positive anaerobic bacteria including pepetosterptococci, microaerophilic streptococci, Propionibacterium acnes, and Actinomyces species are often resistant; therefore; adding an antimicrobial that is effective against these organisms (eg, penicillin) is often necessary.[25, 26]

 

Penicillin is added to metronidazole to cover microaerophilic streptococci, peptostreptococci, Actinomyces species, and Arachnia species when treating intracranial and dental infections.

 

Penicillin is the antimicrobial of choice for bacteremia caused by non beta-lactamase producers; however, if other organisms may be involved in another site, broader coverage is needed.

 

Clindamycin is effective against aerobic gram-positive cocci. However, resistance of the B fragilis group in some centers in the United States recently reached about 40%. This agent can therefore not be used as empiric therapy. Antibiotic-associated colitis due to Clostridium difficile, although associated with most antimicrobials, was first described following clindamycin therapy.

A macrolide or amoxicillin is added to metronidazole to treat S aureus and aerobic streptococci in upper respiratory tract infections.

 

Doxycycline is effective against chlamydial and mycoplasmal infections and is added to most regimens when treating pelvic infections.

 

Oral therapy for peptostreptococci is often substituted for parenteral therapy. Oral agents include clindamycin, amoxicillin and clavulanate, and chloramphenicol.

 

Some of you on this forum seem to really understand the ins and outs of strep and accompanying infections. Your wisdom is appreciated.

Edited by Sweet Cheeks Mom
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