Naeem Raza, Muhammad Usman, Ahsan Hameed.
Chronic plaque psoriasis: Streptococcus Pyogenes throat carriage rate and therapeutic response to oral antibiotics in comparison with oral Methotrexate.
J Coll Physicians Surg Pak Jan ;17(12):717-20.

Objective: To determine the throat carriage rate of Streptococcus pyogenes in patients having chronic plaque psoriasis and the effect of antibiotics as compared with that of oral methotrexate. Design: Quasi-experimental study. Place and Duration of Study : Dermatology Department, Combined Military Hospital, Abbottabad, from January to December 2006. Patients and Methods: Forty patients and 40 age and gender-matched controls were selected. Throat swab for culture of Streptococcus pyogenes was taken from each patient and control. All patients were treated with oral Penicillin V 250 mg, 6 hourly, and oral Rifampicin, 600 mg daily, for 10 days. Pre- and posttherapy ‘Psoriasis Area and Severity Index’ (PASI) were compared. Thirty of these 40 patients were later given oral methotrexate, 5-10 mg weekly, for 04 weeks and pre- and post-therapy PASI were compared. Chi-square and paired-samples t-test were used for data analysis. Results: Throat swab cultures were positive for Streptococcus pyogenes in 05 (12.5%) patients and none (0%) of the controls (p=0.02). Mean pre- and postantibiotic therapy PASI were 15.92 + 05.94 and 15.19 + 06.17 respectively (p=0.078). Mean pre- and postmethotrexate PASI were 15.81+ 5.55 and 8.79 + 4.19 respectively (p <0.01). Conclusion: Throat carriage of Streptococcus pyogenes is common in patients with chronic plaque psoriasis. Short-term antibiotic treatment has no role in routine treatment of chronic plaque psoriasis. However, it would be worthwhile to consider the effects of longterm antibiotics on chronic plaque psoriasis.

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