From the Guidelines
To treat Group A Streptococcus (GAS) soft tissue infection, the primary recommendation is a combination of penicillin and clindamycin, as this regimen has been shown to be effective in treating necrotizing fasciitis and streptococcal toxic shock syndrome caused by group A streptococci 1. The standard regimen for GAS soft tissue infection includes:
- Penicillin, which is effective against group A streptococci
- Clindamycin, which has been shown to suppress toxin production and modulate cytokine production, and has been demonstrated to be effective in treating GAS infections 1 For patients with severe infections, such as necrotizing fasciitis, prompt surgical consultation is recommended, and empiric antibiotic treatment should be broad, covering both aerobic and anaerobic microbes 1. In addition to antibiotics, supportive care is important, including:
- Resting the affected area
- Applying warm compresses to reduce pain and promote circulation
- Elevating the affected limb if possible to reduce swelling
- Taking over-the-counter pain relievers like acetaminophen or ibuprofen as needed It's crucial to complete the full course of antibiotics even if symptoms improve before finishing the medication, to prevent antibiotic resistance and ensure complete eradication of the bacteria. The use of intravenous immunoglobulin (IVIG) to treat streptococcal toxic shock syndrome is not recommended with certainty, due to limited evidence 1. Overall, prompt treatment with penicillin and clindamycin, along with supportive care, is essential to prevent the infection from spreading or developing into more serious conditions like cellulitis or sepsis.
From the FDA Drug Label
In cases of β-hemolytic streptococcal infections, treatment should continue for at least 10 days. Uncomplicated skin and skin structure infections due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiae Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy.
The treatment for Group A Streptococcus (GAS) soft tissue infection is:
- Clindamycin (PO) for at least 10 days in cases of β-hemolytic streptococcal infections 2
- Azithromycin (PO) as an alternative to first-line therapy in individuals who cannot use first-line therapy for pharyngitis/tonsillitis caused by Streptococcus pyogenes 3 Note: Penicillin is usually the drug of choice for Streptococcus pyogenes infection and the prophylaxis of rheumatic fever 3
From the Research
Treatment for Group A Streptococcus (GAS) Soft Tissue Infection
The treatment for Group A Streptococcus (GAS) soft tissue infection typically involves the use of antibiotics. According to 4, azithromycin is effective against Streptococcus pyogenes, which is the causative agent of GAS infections.
- Azithromycin is administered once daily and achieves clinically relevant concentrations at sites of infection 4
- It is also active against other pathogens responsible for skin and soft tissue infections, including Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus 4
Alternative Treatment Options
In addition to azithromycin, other antibiotics such as clindamycin, lincomycin, and erythromycin may be used to treat GAS soft tissue infections, especially in patients with penicillin hypersensitivity 5.
- Clindamycin is recommended for empirical antibacterial therapy of community-acquired skin and soft tissue infections in penicillin-allergic patients 6
- Linezolid is also effective against Gram-positive organisms, including MRSA, and may be used as an alternative treatment option 7
Aggressive Medical Regimen
In severe cases of GAS soft tissue infections, an aggressive medical regimen including intravenous polyspecific immunoglobulin (IVIG) may be used in conjunction with a conservative surgical approach 8.