Dog bite wounds of 39 children (ages one to 16 years) were cultured and irrigated. Cultures showed various organisms but were of no predictive value for development of infection. By using a table of random numbers, patients were assigned to either oral penicillin V-K (100,000 U/kg/day every 6 h) or placebo for two days. All patients were seen in follow-up in three to four days and again at seven to 10 days or earlier if signs of inflammation occurred. The mean patient age, location and type of wound, and initial wound care were similar in the two treatment groups. Three of 39 (7.7%) children enrolled in the study developed infection at the bite site, including two of 19 in the penicillin group and one of 20 in the placebo group. In our study, prophylactic penicillin failed to prevent infection in dog bite wounds. Good local care on presentation seems to be the most important factor in determining future infection.

solution B is 3 gm/dL, or 3%, not 3 mg/dL.

We evaluated the efficacy of rifampin in eradicating chronic pharyngeal carriage of group A streptococci. Carriers were defined as healthy children whose throat cultures showed persistence of group A streptococci 3 weeks after receiving benzathine penicillin G intramuscularly. Subsequent M and T typing of group A streptococcal isolates and limited serologic studies confirmed that enrolled patients were carriers. Thirty-eight carriers (37 completed the study) were randomly assigned to three groups: group 1 (13 patients) received no treatment; group 2 (10) received benzathine penicillin intramuscularly; group 3 (14) received benzathine penicillin intramuscularly plus rifampin orally (10 mg/kg twice a day for eight doses). Throat cultures were obtained every 3 weeks for at least 9 weeks. Group 2 and 3 patients who still had positive cultures 3 weeks after treatment were crossed to the opposite group. Cultures became negative in 93% (13 of 14) of patients in group 3, compared with 23% in group 1 and 30% in group 2 (P less than 0.001 and P less than 0.01, respectively). Including patients crossed over, the penicillin plus rifampin regimen was effective in 17 (89%) of 19 treatment courses and was significantly superior to no therapy or to penicillin alone (P less than 0.0005 and P less than 0.005, respectively). We conclude that rifampin plus benzathine penicillin intramuscularly is an effective regimen for those selected patients in whom eradication of group A streptococcal carriage is judged to be desirable.

Chronic pharyngeal carriage of group A streptococci (GAS) is of concern to many physicians and families. No therapy has proved effective in eliminating GAS from asymptomatic patients with positive cultures after penicillin (P). Rifampin (Rif) has excellent in vitro activity against GAS. Because Rif effectively terminates meningococcal and H. influenzae carriage, we evaluated Rif for GAS carriage. Otherwise healthy children 2 to 16 y.o. were defined as carriers when a throat culture 3 weeks after IM benzathine P (600,000 u ≤60 lbs., 1.2 million u >60 lbs.) for GAS pharyngitis showed persistence of the same GAS serotype. Thirty-seven carriers were randomly assigned to 3 groups: Group I (13 patients): no treatment; Group II (10): repeat IM benzathine P; Group III (14): repeat IM benzathine P and oral Rif (10 mg/kg BID × 8 doses). Groups were comparable in age, sex, and socio-economic status. Cultures were obtained every 3 weeks for at least 9 weeks. Group II and III patients culture-positive 3 weeks after treatment were crossed to the opposite group. At 3 weeks, 10/13 (77%) in Group I, 7/10 (70%) in Group II, but only 1/14 (7%) in Group III were GAS-positive. Group III differs from Group I (p< 0.001) and from Group II (p<0.01). In the cross-over phase, 4/4 treated Group II patients were negative after P + Rif. Overall, P + Rif was successful in 17/18 courses, differing from Groups I and II (each p<0.005). These data show oral Rifampin plus IM penicillin to be effective in eradicating chronic group A streptococcal carriage.

We undertook a randomized trial to compare holding room treatment vs hospitalization of patients with childhood status asthmaticus. Two thirds of 51 patients were discharged from a holding room within 24 hours (mean 11.8 +/- 4.61 hours); the others required hospitalization. One third of 52 hospitalized patients received less than or equal to 1 day of intravenously administered therapy, and two thirds received less than 2 days of therapy (mean 45.6 +/- 12 hours). There were no statistically significant differences in recurrence rates between the two groups in the 28 days following status asthmaticus. For patients receiving less than or equal to 1 day of therapy, the holding room cost was $526 +/- $226 vs $1439 +/- $339 for hospitalized patients (P less than 0.001). Thus, holding room therapy for childhood status asthmaticus is both medically and economically effective.