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Outcomes in Children Treated for Perineal Group A Beta-hemolytic Streptococcal Dermatitis

Olson, Dan MD; Edmonson, M. Bruce MD, MPH

Pediatric Infectious Disease Journal: November 2011 - Volume 30 - Issue 11 - pp 933-936
doi: 10.1097/INF.0b013e318228492a
Original Studies

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.

From the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Address for correspondence: M. Bruce Edmonson, MD, MPH, 2870 University Ave., Madison, WI 53705. E-mail: Edmonson@pediatrics.wisc.edu.

The authors have no funding or conflicts of interest to disclose.

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© 2011 by Lippincott Williams & Wilkins, Inc.