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Is Streptococcus pyogenes resistant or susceptible to Trimethoprim-Sulfamethoxazole?

Bowen, Asha C., Lilliebridge, Rachael A., Tong, Steven Y. C., Baird, Robert W., Ward, Peter, McDonald, Malcolm I., Currie, Bart J. and Carapetis, Jonathan R. (2012). Is Streptococcus pyogenes resistant or susceptible to Trimethoprim-Sulfamethoxazole?. Journal of Clinical Microbiology,50(12):4067-4072.

Document type: Journal Article
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IRMA ID bsmithxPUB110
NHMRC Grant No. 545234
605845
605829
Title Is Streptococcus pyogenes resistant or susceptible to Trimethoprim-Sulfamethoxazole?
Author Bowen, Asha C.
Lilliebridge, Rachael A.
Tong, Steven Y. C.
Baird, Robert W.
Ward, Peter
McDonald, Malcolm I.
Currie, Bart J.
Carapetis, Jonathan R.
Journal Name Journal of Clinical Microbiology
Publication Date 2012
Volume Number 50
Issue Number 12
ISSN 0095-1137   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84869236202
Start Page 4067
End Page 4072
Total Pages 6
Place of Publication Washington, United States
Publisher American Society for Microbiology
HERDC Category C1 - Journal Article (DIISR)
Abstract Streptococcus pyogenes is commonly believed to be resistant to trimethoprim-sulfamethoxazole (SXT), resulting in reservations about using SXT for skin and soft tissue infections (SSTI) where S. pyogenes is involved. S. pyogenes' in vitro susceptibility to SXT depends on the medium's thymidine content. Thymidine allows S. pyogenes to bypass the sulfur-mediated inhibition of folate metabolism and, historically, has resulted in apparently reduced susceptibility of S. pyogenes to sulfur antibacterials. The low thymidine concentration in Mueller-Hinton agar (MHA) is now regulated. We explored S. pyogenes susceptibility to SXT on various media. Using two sets of 100 clinical S. pyogenes isolates, we tested for susceptibility using SXT Etests on MHA containing defibrinated horse blood and 20 mg/liter β-NAD (MHF), MHA with sheep blood (MHS), MHA alone, MHA with horse blood (MHBA), and MHA with lysed horse blood (MHLHBA). European Committee on Antibacterial Susceptibility Testing (EUCAST) breakpoints defined susceptibility (MIC, ≤1 mg/liter) and resistance (MIC, >2 mg/liter). In study 1, 99% of S. pyogenes isolates were susceptible to SXT on MHA, MHBA, and MHLHBA, with geometric mean MICs of 0.04, 0.04, and 0.05 mg/liter, respectively. In study 2, all 100 S. pyogenes isolates were susceptible to SXT on MHF, MHS, MHA, and MHLHBA with geometric mean MICs of 0.07, 0.16, 0.07, and 0.09 mg/liter, respectively. This study confirms the in vitro susceptibility of S. pyogenes to SXT, providing support for the use of SXT for SSTIs. A clinical trial using SXT for impetigo is ongoing.

DOI http://dx.doi.org/10.1128/JCM.02195-12   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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