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• W2913987341 abstract "We appreciate the authors’ criticisms of our paper [1Urbano F Urbano P Azithromycin in healthy adults?.Clin Microbiol Infect. 2001; 7 (397): 396Abstract Full Text Full Text PDF PubMed Google Scholar], but we wish to clarify some of their misunderstandings. Our paper's [2Putnam S Gray G Biedenback D Jones R Pharyngeal colonization prevalence rates for Streptococcus pyogenes and Streptococcus pneumoniae in a respiratory chemoprophylaxis intervention study using azithromycin.Clin Microbiol Infect. 2000; 6: 2-8Crossref PubMed Scopus (15) Google Scholar] focus was rather simple. Using data from a previously published clinical trial [3Gray G McPhate D Leinonen M et al.Weekly oral azithromycin as prophylactic therapy against bacterial causes of acute respiratory disease.Clin Infect Dis. 1998; 26 (10): 103Crossref PubMed Scopus (36) Google Scholar], we sought to assess changes in antimicrobial susceptibility levels of two common respiratory pathogens (Streptococcus pyogenes and S. pneumoniae) among US military personnel enrolled in a respiratory disease chemoprophylaxis trial. Our findings, based upon limited data, indicated that there was little or no change in the minimum inhibitory concentrations (MICs) before and after the administration of the chemoprophylactic drugs. We agree with Urbano and Urbano that using a single 1.2 million unit injection of benzathine penicillin G (BPG) injection is limited in its antimicrobial scope. We also recognize that the prophylactic effect of BPG against S. pyogenes is expected to protect an individual for only 2–4 weeks [4Kaplan EL Berrios X Speth J Siefferman T Guzman B Quesny F Pharmacokinetics of benzathine penicillin G serum levels during the 28 days after intramuscular injection of 1 200 000 units.J Pediatr. 1989; 115 (50): 146Abstract Full Text PDF PubMed Scopus (46) Google Scholar]. However, for more than 40 years, the US Department of Defense has successfully used mass BPG prophylaxis to prevent and control respiratory infection epidemics among military trainees [5Schreier A Hockett V Seal J Mass prophylaxis of epidemic streptococcal infections with benzathine penicillin G.N Engl J Med. 1958; X (8): 1231Crossref Scopus (9) Google Scholar, 6Thomas RJ Conwill DE Morton DE Brooks TJ Holmes CK Mahaffey WB Penicillin prophylaxis for streptococcal infections in the United States Navy and Marine Corps recruit camps, 1951–85.Rev Infect Dis. 1988; 10 (30): 125Crossref PubMed Scopus (33) Google Scholar, 7Gunzenhauser JD Longfield JN Brundage JF Kaplan EL Miller RN Brandt CA Epidemic streptococcal disease among Army trainees, July 1989 through June 1991.J Infect Dis. 1995; 172 (31): 124Crossref PubMed Scopus (39) Google Scholar, 8Brundage JF Gunzenhauser JD Longfield JN et al.Epidemiology and control of acute respiratory diseases with emphasis on group A beta‐hemolytic streptococcus: a decade of U.S. Army experience.Pediatrics. 1996; 97 (70): 964PubMed Google Scholar, 9Gray GC Callahan JD Hawksworth AW Fisher CA Gaydos JC Respiratory diseases among U.S. military personnel: countering emerging threats.Emerg Infect Dis. 1999; 5 (85): 379Crossref PubMed Scopus (178) Google Scholar]. This protection has been broad, frequently exceeding the magnitude of that which would be explained by the reduction of streptococcal infections alone [10Gunzenhauser JD Brundage JF McNeil JG Miller RN Broad and persistent effects of benzathine penicillin G in the prevention of febrile, acute respiratory disease.J Infect Dis. 1992; 166 (73): 365Crossref PubMed Scopus (20) Google Scholar]. The protection has also been prolonged, especially among US Army trainees, where a single dose of BPG will often protect a cohort for up to 8 weeks [10Gunzenhauser JD Brundage JF McNeil JG Miller RN Broad and persistent effects of benzathine penicillin G in the prevention of febrile, acute respiratory disease.J Infect Dis. 1992; 166 (73): 365Crossref PubMed Scopus (20) Google Scholar]. Although not well understood, the broad and persistent control is thought to be due to the impact mass BPG prophylaxis has on endemic respiratory pathogens in a training cohort as a whole. Such cohorts experience little mixing with other cohorts and benefit from a mass BPG influenced ‘herd protection’. As several ‘outbreaks’ of respiratory disease had occurred among US Marine trainees in Southern California in the late 1980s and early 1990s, the value of BPG interventions was questionable, considering the mixed etiology of infecting agents [11Gray GC Escamilla J Hyams KC Struewing JP Kaplan EL Tupponce AK Hyperendemic Streptococcus pyogenes infection despite prophylaxis with penicillin G benzathine.N Engl J Med. 1991; 325 (7): 92Crossref PubMed Scopus (43) Google Scholar, 12Reichler M, Reynolds R, Schwartz B, et al. Epidemic of pneumococcal pneumonia at a military training camp. In: 31st Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, IL, American Society for Microbiology, 1991.Google Scholar, 13Gray GC Duffy LB Paver RJ Putnam SD Reynolds RJ Cassell GH Mycoplasma pneumoniae: a frequent cause of pneumonia among U.S. Marines in southern California.Mil Med. 1997; 162 (6): 524PubMed Google Scholar]. There was also concern that BGP prophylaxis might eventually select for penicillin-resistant/tolerant S. pyogenes strains and the US Department of Defense would be wise to identify alternative therapies. In contrast to Urbano and Urbano's comments, we believe the literature suggests that the threat of selecting for penicillin tolerance/resistance to be very real [14Cohen ML Epidemiology of drug resistance: implications for a post‐antimicrobial era.Science. 1992; 257 (5): 1050Crossref PubMed Scopus (1105) Google Scholar, 15Kim SK Kaplan EL Association of penicillin tolerance with failure to eradicate Group A streptococci from patients with pharyngitis.J Pediatr. 1985; 107 (4): 681Abstract Full Text PDF PubMed Scopus (137) Google Scholar, 16Grahn E Holm SE Roos K Penicillin tolerance in beta‐streptococci isolated from patients with tonsillitis.Scand J Infect Dis. 1987; 19 (6): 421Crossref PubMed Scopus (67) Google Scholar]. We were seeking an alternative antibiotic intervention with broad impact, for use in fast-moving respiratory epidemics. The aim of the original study [3Gray G McPhate D Leinonen M et al.Weekly oral azithromycin as prophylactic therapy against bacterial causes of acute respiratory disease.Clin Infect Dis. 1998; 26 (10): 103Crossref PubMed Scopus (36) Google Scholar] was to compare the efficacy of azithromycin with the then routine outbreak intervention of a single injection of BPG [9Gray GC Callahan JD Hawksworth AW Fisher CA Gaydos JC Respiratory diseases among U.S. military personnel: countering emerging threats.Emerg Infect Dis. 1999; 5 (85): 379Crossref PubMed Scopus (178) Google Scholar]. We compared the interventions for their protection against a number of respiratory pathogens. We agree that the isolation procedure (throat swabs) for the recovery of both strains was not the optimal method and may have underestimated the true prevalence of both species among our trainees. However, the same method was used for the pre- and post collection in all three treatment groups, and it is unlikely that a reduction in detection would have markedly changed our findings. Finally, we agree with Urbano and Urbano that the statistical methods and analysis used in this study were not optimal, but they were adequate for the generalized MIC comparison between groups. Cross-sectional samplings were used under a simple pre- and post-treatment design and the results, with limited statistical power due to low prevalences, should be viewed as hypothesis-generating. We also agree that further chemoprophylaxis studies are merited to fully satisfy our observations that chemoprophylaxis with azithromycin did not appear to induce antibiotic resistance in either S. pneumoniae or S. pyogenes." @default.
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• W2913987341 date "2001-07-01" @default.
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• W2913987341 title "Response" @default.
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