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Persistence of GABHS in toothbrushes, oral appliances

Oral tools harboring group A b-hemolytic streptococci may allow resistance to penicillin therapy.

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December 1998

WASHINGTON, D.C. - Toothbrushes and other removable orthodontic appliances with group A b-hemolytic streptococci (GABHS) isolates may contribute to the persistence of the infection and allow apparent failure of penicillin therapy, according to a study by Itzhak Brook, MD, and Alan E. Gober, MD, of the department of pediatrics at Georgetown University.

The study examined 104 children (mean age of 8 years) suffering from acute GABHS pharyngotonsillitis. They presented with a sore throat and either an anterior cervical adenitis, a temperature higher than 101° F, pharyngeal or tonsillar exudate or pharyngeal injection. The children were seen consecutively for over seven months in a suburban private practice clinic.

Pharyngotonsillitis cultures were taken two to four days after 10 days of treatment with penicillin V potassium. The penicillin was given in three divided doses a day for 10 days and was administered orally. At that time, they were asked to bring their toothbrushes and any removable orthodontic appliances for cultures.

GABHS were isolated from 11 (11%) toothbrushes and 18 (17%) of the pharyngotonsillar cultures at the second visit, after completion of therapy. Of the 18 who presented with pharyngotonsillar cultures still positive with GABHS, five (28%) had toothbrushes that were colonized by GABHS. Three of those five were symptomatic. GABHS were also isolated from four (19%) of the 21 removable orthodontic appliances studied. Two of these four children also experienced penicillin treatment failure.

In vitro studies were conducted of new toothbrushes inoculated with GABHS. Ten were rinsed and 10 were unrinsed daily for 21 days and specimens of their surface was cultured. The unrinsed brushes maintained the presence of GABHS for 15 days, with the numbers steadily declining. However, GABHS was not detected in the rinsed toothbrushes after three days (see chart).

The data suggest that toothbrushes and orthodontic equipment which are not cleaned thoroughly could become a host to GABHS. The researchers noted that further study is needed to determine the precise impact of penicillin therapy, as well as, proper methods to cleanse oral appliances and toothbrushes.

"It is difficult, however, to know whether the recovery of GABHS in toothbrushes and removable orthodontic appliances of these patients with positive pharyngotonsillar cultures may be the cause, or the result, of the pharyngotonsillar presence of GABHS," the researchers said.

For your information:

• Brook I, Gober AE. Persistence of group A b-hemolytic streptococci in toothbrushes and removable orthodontic appliances following treatment of pharyngotonsillitis. Arch Otolaryngol Head Neck Surg 1998;124:993-995.

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