Antibiotic Treatment for Recurrent AGN

ü Although the exact mechanism leading to recurrence of APSGN has not yet been determined, three possible explanations have been postulated:

o the suppression of immune response against nephritogenic streptococcal strains due to early antibiotic therapy

o an absence of natural immune responses against nephritogenic streptococcal components without antibiotic therapy

o a failure to exclude microbial agents through the digestive and respiratory tract due to IgA deficiency

ü Since only 10-20% of patients presented with sore throat have a positive culture for group A streptococci, the following clinical scoring is used to increase the accuracy of diagnosis for the prescription of antibiotics:

o Temperature higher than 38 ^º C and no cough = 1 point

o Tender anterior cervical adenopathy = 1 point

o Tonsillar swelling or exudates = 1 point

o Age between 3 and 14 years = 1 point

o Age ≥44 years = –1 point

Points	Recommendations
0 – 1	Antibiotic treatment is not necessary and culture is unneccesary
2 – 3	Obtain culture and give antibiotic treatment only when result is positive
4	Administer antibiotic treatment

ü  Choose an agent with greater beta-lactamase stability than the previous agent used:

o If a full course of penicillin was completed as initial therapy, a first-generation cephalosporin may be used

o If a first-generation cephalosporin was used for initial therapy, a second- or third-generation cephalosporin may be used

o Alternative agents include amoxicillin-clavulanate or clindamycin. 

References:

1. Medscape. Acute Poststreptococcal Glomerulonephritis Treatment & Management. http://emedicine.medscape.com/article/980685-treatment#a1156
2.  Atypical Clinical Manifestations of Acute Poststreptococcal Glomerulonephritis. http://cdn.intechopen.com/pdfs-wm/22828.pdf
3. UpToDate. http://www.uptodate.com.ezp.imu.edu.my/contents/treatment-and-prevention-of-streptococcal-tonsillopharyngitis?source=see_link#H16