From the Guidelines
Clindamycin is recommended for the treatment of invasive Group A Streptococcal (iGAS) infections, typically administered at a dose of 600-900 mg intravenously every 8 hours for adults. For iGAS infections, clindamycin is usually given in combination with a beta-lactam antibiotic such as penicillin G (2-4 million units IV every 4-6 hours) or a cephalosporin, as seen in guidelines for the diagnosis and management of skin and soft-tissue infections 1. The duration of therapy generally ranges from 10-14 days, though treatment may be extended to 21 days for complicated infections such as necrotizing fasciitis or streptococcal toxic shock syndrome. Some key points to consider when using clindamycin for iGAS infections include:
- Clindamycin inhibits protein synthesis, reducing toxin production even in high bacterial loads, which helps combat the toxin-mediated effects of iGAS infections 1.
- Clindamycin's efficacy is not affected by the inoculum size or growth phase of the bacteria, making it effective even when bacterial counts are high.
- Patients should be monitored for potential side effects including diarrhea, Clostridioides difficile infection, and allergic reactions.
- Transition to oral therapy may be considered once the patient shows clinical improvement, with oral clindamycin typically dosed at 300-450 mg every 6-8 hours. It's also important to note that the definition of invasive GAS infection includes illness associated with the isolation of GAS from a normally sterile body site, such as blood, cerebrospinal fluid, joint aspirate, pericardial/peritoneal/pleural fluids, bone, endometrium, deep tissue or abscess at operation or post mortem, as stated in guidelines for prevention and control of group a streptococcal infection in acute healthcare and maternity settings in the uk 1.
From the FDA Drug Label
In cases of β-hemolytic streptococcal infections, treatment should be continued for at least 10 days The recommended treatment regimen for invasive Group A Streptococcal (iGAS) infections using Clindamycin is:
- Adults: 600 mg to 1,200 mg per day in 2,3 or 4 equal doses for serious infections, and 1,200 mg to 2,700 mg per day in 2,3 or 4 equal doses for more severe infections.
- Pediatric Patients 1 month of age to 16 years: 20 to 40 mg/kg/day in 3 or 4 equal doses.
- Treatment should be continued for at least 10 days in cases of β-hemolytic streptococcal infections 2
From the Research
Treatment Regimen for iGAS Infections using Clindamycin
The recommended treatment regimen for invasive Group A Streptococcal (iGAS) infections using Clindamycin is as follows:
- Clindamycin can be added to β-lactams in severe clinical presentations, including necrotizing fasciitis or streptococcal toxic shock syndrome, to reduce mortality and morbidity 3.
- Clindamycin treatment of patients with severe iGAS infections substantially reduces mortality, and this effect may be enhanced by concurrent treatment with intravenous immunoglobulin (IVIG) 4.
- Clindamycin affects Group A Streptococcus virulence factors and improves clinical outcome, and it is recommended to administer Clindamycin as soon as possible to patients with necrotizing fasciitis 5.
Key Considerations
- The use of Clindamycin and IVIG in treatment of iGAS infection, and the need for prophylactic antibiotics in close contacts, remains contentious, but studies suggest that Clindamycin treatment can reduce mortality 4.
- Prompt antibiotics therapy and early surgical debridement of infected tissue are essential in the management of invasive Group A streptococcal disease 6.
- The efficacy of Clindamycin has been outlined in the treatment of serious streptococcal infections, and it is considered a useful addition to β-lactams in severe cases 7.