Group A Streptococcal Infection-Biochemical and Pharmacological Aspects

RAMONA MIHAELA NEDELCUTA1, VLAD DUMITRU BALEANU2*, DRAGOS VIRGIL DAVITOIU3, TIBERIU STEFANITA TENEA COJAN4, ANCA PASCAL5, BOGDAN SOCEA6, COSMIN ALEXANDRU CIORA7, GIGI CALIN1 1University of Medicine and Pharmacy of Craiova, Pediatrics Department, 2 Petru Rares Str., 200349, Craiova, Romania 2University of Medicine and Pharmacy of Craiova, Surgery Department, Clinical Emergency Hospital St. Pantelimon, 340-342 Pantelimon Road, 021659, Bucharest, Romania 3 University of Medicine and Pharmacy of Bucharest, Surgery Department, Clinical Emergency Hospital Sf. Pantelimon, 340-342 Pantelimon Road, 021659, Bucharest, Romania 4University of Medicine and Pharmacy of Craiova, Department of Surgery, CFR Hospital, Stirbei-Voda Str., 200374,Craiova, Romania 5Department of Anesthesiology and Intensive Care, Universitary Emergency Hospital Bucharest, 169 Splaiul Indepenei, 050098, Bucharest, Romania 6 Sf. Pantelimon Emergency Clinical Hospital, 340-342 Pantelimon Road, 021659, Bucharest, Romania 7 Carol Davila University of Medicine and Pharmacy, Discipline of Gastroenterology and Hepatology, 8 Eroii Revolutiei Blvd., 050474, Bucharest, Romania

The medicine of the last years is evidence-based -most of the theoretical information that has occurred in the past 10 years is already out of date.The Axioma of Classical Pediatrics -Any Group A Haemolytic Beta Streptococcus must be treated with Penicillin G is no longer relevant The results of a study at the Hospital Philanthropy from Craiova are not at all surprising, overlapped with those found in medical practice.Age entails moving the diagnosis to the baby, sensitivity to penicillin occurs in only ¼ of children, microbial resistance to the antibiotic is common in many antibiotics.
Keywords: streptococcus, children, antibiotics Streptococcus hemolytic beta-Streptococcus A is a round oval gram positive coccus, disposed in pairs of chains, immobile, optionally anaerobic, catalase-negative, nonspore-forming. Some strains are encapsulated, the capsule being a marker of virulence.
Blood haemolysis by PYR assay identifies pyrrolidonyl amidase synthesis; Group A streptococcal proliferation is inhibited by bacitracin; based on carbohydrate composition of bacterial antigens (Lancerfield) group B hemolytic group A, streptolysins causing hemolysis; in the wall there is M protein with antiphagocytic role.
The source of infection is the sick man or the asymptomatic chronic pharyngeal carriers, through Pflügge drops or direct contact because the bacteria does not resist the external environment.
There are classical axioms. Are they up to date? The results speak for themselves: -The drug of chose is penicillin G or V and, in those allergic to erythromycin or oxacillin.
-No antibiotic for group A haemolytic beta streptococcus is performed.
History: Penicillin's microbial resistance began with the invention of Penicillin in 1928 by Alexander Fleming, which represented a big step in microbial therapy.
The explanation was given in 1885 by Victor Babes, who observed the inhibitory action of substances elaborate by microorganisms.
In 1930, the first cases of Penicillin microbial resistance were already observed [16].
We selected a group of 174 patients by group A haemolytic beta-streptococcal confirmed by exudate from a total of 1273 hospitalized children over a whole year.

Results and discussions
internalization in the tonsillar crypt; -different response in vivo -in vitro; -abuse of antibiotics at younger age; -the local floral defenses destroyed; -multiple hospital admission for other affections; -alginate theory, possibly as in pseudomonas defense in mucoviscidosis; -double etiology of angina -streptococcus and staphylococcus [22,23].

Conclusions
The future is evidence-based medicine where YES and NOT are relative, not absolute.
Axioms become theorems that will need to be demonstrated; otherwise the proof of the time drops.
Polypragmasia forces accelerated entry into a new age, where new bactericidal drugs with a very wide spectrum will be invented, in which the microbiota will have to be strengthened and blossomed where immune barriers will need to be stimulated efficiently and quickly.
There is no disease but the patient is a dictum of old pediatrics strengthens by the present times The well-known semiological picture changes rapidly for various illnesses and the tendency of establishing protocols is increasing.
The antibiotic should be a mandatory step to indicate the sensitivity of any germ.
Questions remain to be answered: The benefit could be for the doctor, protected by the protocol, but what about complicated affections? How do we effectively combine different protocols? Can the protocol be assimilated to an axiom but do their axioms have their place in pediatrics?  Some explanations for the occurrence of the disease at infancy may be: -Close intimate intra-family contact -Predigestion of food under the action of salivary amylase from the mother, still practiced in our country -Insufficient sterilization of the teat, pacifier, as well as wetting it before it is given to the baby [17][18][19][20][21].
Possible explanations and theories: