Elsevier

Biological Psychiatry

Volume 57, Issue 7, 1 April 2005, Pages 788-792
Biological Psychiatry

Original articles
Antibiotic prophylaxis with azithromycin or penicillin for childhood-onset neuropsychiatric disorders

https://doi.org/10.1016/j.biopsych.2004.12.035Get rights and content

Background

The acronym PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) describes a subgroup of children with obsessive-compulsive disorder and/or tic disorder that experience symptom exacerbations following streptococcal infections. We hypothesized that the prevention of streptococcal infections among children in the PANDAS subgroup would decrease neuropsychiatric symptom exacerbations.

Methods

Twenty-three subjects with PANDAS were enrolled in a double blind, randomized controlled trial. Antibiotic prophylaxis with penicillin or azithromycin was administered for 12 months. Rates of streptococcal infections and neuropsychiatric symptom exacerbations were compared between the study year and the baseline year prior to entry.

Results

Significant decreases in streptococcal infections during the study year were found with a mean of .1 (.3 SD) per subject, compared to the baseline year with 1.9 (1.2 SD) in the penicillin group and 2.4 (1.1 SD) in the azithromycin group [p<.01]. Significant decreases in neuropsychiatric exacerbations during the study year were also found with a mean of .5 (.5 SD) per subject in the penicillin group and .8 (.6 SD) in the azithromycin group, compared to the baseline year with 2.0 (.9 SD) in the penicillin group and 1.8 (.6 SD) in the azithromycin group [p<.01].

Conclusions

Penicillin and azithromycin prophylaxis were found to be effective in decreasing streptococcal infections and neuropsychiatric symptom exacerbations among children in the PANDAS subgroup.

Section snippets

Subjects

Children with a history of a sudden onset or abrupt exacerbations of tic or obsessive-compulsive symptoms associated with GAS infection were recruited for this study from July 1999 through September 2002. Recruitment was achieved by advertisements placed in the newsletters of the Tourette’s syndrome Association and the Obsessive Compulsive Foundation, direct mailings to child psychiatrists and pediatricians in the Washington D.C. metro area, and on the National Institute of Mental Health PANDAS

Study subjects

Between July 1999 and September 2002, 248 telephone screenings were conducted and 51 children were seen in the outpatient clinic for an in-person assessment. Thirty-three of these met criteria for study entry. Nine children either chose not to participate in the study (n = 7) or were excluded after the baseline evaluation (n = 2). Of the latter group, one subject was unable to tolerate the baseline blood draw and one subject was unable to swallow the study capsules. One subject dropped out of

Discussion

Both the penicillin group and the azithromycin group demonstrated significant decreases in GAS infections during the study year, compared to the year prior to receiving antibiotic prophylaxis. The results indicate that both penicillin and azithromycin are effective in preventing GAS infections when taken as prescribed. There was only one GAS infection in each group over a 12-month observation period, which represents a 96% reduction in GAS infections during the year of antibiotic prophylaxis

References (24)

  • W.K. Goodman et al.

    The Yale Brown obsessive compulsive scale (Y-BOCS)I. Development, use and reliability

    Arch Gen Psychiatry

    (1989)
  • J.J. Granizo et al.

    Streptococcus pyogenes resistance to erythromycin in relation to macrolide consumption in Spain (1986-1997)

    J Antimicrob Chemother

    (2000)
  • Cited by (0)

    View full text