In the evaluation of treatment failure in pharyngitis it is necessary to distinguish between persistence of the original streptococcus and acquisition of a new strain. We used the analysis of restriction fragment length polymorphism (RFLP) of total DNA and of ribosomal DNA (rDNA) regions (ribotypes) as epidemiological tools to compare 43 pre- and post-treatment strains obtained from 20 patients. In 16 cases pre- and post-treatment strains gave indistinguishable RFLP patterns of total DNA, strongly suggesting relapse with the same strain. However, in four cases different patterns were obtained for the pre- and post-treatment isolates, indicating recurrence due to the acquisition of a new strain. Ribotyping did not improve discrimination among strains. Thus, analysis of DNA RFLP is a promising method for distinguishing recurrence from relapse in failures of pharyngitis treatment.


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