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

• Published in: Biological psychiatry (1969) Vol. 57; no. 7; pp. 788 - 792
• Main Authors: Snider, Lisa A., Lougee, Lorraine, Slattery, Marcia, Grant, Paul, Swedo, Susan E.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2005; Elsevier Science
• Subjects: Antibiotic Prophylaxis; autoimmune; Azithromycin - therapeutic use; Biological and medical sciences; Child; Child, Preschool; Double-Blind Method; Female; Follow-Up Studies; Humans; Male; Medical sciences; Nervous system involvement in other diseases. Miscellaneous; Neurology; obsessive-compulsive disorder; Obsessive-Compulsive Disorder - drug therapy; Obsessive-Compulsive Disorder - microbiology; Penicillins - therapeutic use; Psychiatric Status Rating Scales; Retrospective Studies; Streptococcal; Streptococcal Infections - complications; Streptococcal Infections - drug therapy; Streptococcal Infections - microbiology; tic disorder; Treatment Outcome; tic disorder; autoimmune; Streptococcal; obsessive-compulsive disorder; Human; Autoimmunity; Obsessive compulsive disorder; Nervous system diseases; Anxiety disorder; Azithromycin; Macrolide; Involuntary movement; Tic; Infection; Prevention; Penicillin derivatives; Antibiotic; Age of onset; Streptococcal infection; Bacteriosis; Developmental stage; Neurological disorder; Child
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/j.biopsych.2004.12.035

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