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Macrolide resistance in group A Streptococcus (GAS) — and the unfortunate consequences of such resistance — are of increasing concern worldwide. Investigators in the U.S. recently presented two case reports from their own practice and reviewed the literature for relevant studies published between 2000 and 2011.
The case reports described two children in whom streptococcal pharyngitis was diagnosed by rapid antigen-detection test; both were treated with azithromycin. Soon thereafter, they presented with migratory arthritis, increased antistreptolysin O titers, leukocytosis, and elevated erythrocyte sedimentation rates. They were determined to have acute rheumatic fever and recovered without sequelae. In one case, a subsequent throat culture r…