Penicillin-resistant Bacteria in the Mouths and Throats of Children Receiving Continuous Prophylaxis against Rheumatic Fever

Abstract

An investigation comparing the mouth flora of three groups of individuals living free in the community was carried out. Seventy-four persons were studied, including 8 normal individuals and 66 patients of whom 45 were on sulfadiazine prophylaxis against rheumatic fever and 21 were on penicillin prophylaxis. A culture of the anterior tooth-gum margin and a culture of the throat were obtained from each individual and the sample planted simultaneously on plain blood agar and agar with two units of penicillin per ml. Eighty-one per cent of the individuals on penicillin prophylaxis demonstrated the presence of alpha streptococci resistant to two units of pencillin per ml at one or both sites. No penicillin resistant alpha streptococci were found in any individual in either of the other two groups. The implications of penicillin resistance to the therapy of bacterial endocarditis are discussed and it is suggested that a large scale study of this disease be undertaken to determine whether or not long term penicillin prophylaxis against recurrent rheumatic fever is a significant problem in the development and prognosis of cases of bacterial endocarditis.