Does antibiotic augmentation cover Streptococcal (strep) infections?

From the Guidelines

Yes, antibiotic augmentation can cover streptococcal infections, particularly with medications like amoxicillin-clavulanate (Augmentin) or penicillin plus clindamycin for more severe cases like necrotizing fasciitis. The choice of antibiotic depends on the severity and type of infection, as well as the presence of other bacteria. For typical strep throat (Group A Streptococcus), standard dosing for adults is typically 875mg amoxicillin/125mg clavulanate twice daily for 10 days, or 500mg/125mg three times daily 1. However, for uncomplicated strep throat, plain amoxicillin or penicillin is often preferred as first-line treatment since Group A Streptococcus rarely produces beta-lactamases, making the clavulanic acid component unnecessary 1. The augmented formulation is more appropriate for mixed infections or when beta-lactamase producing organisms might be present. Common side effects include diarrhea, nausea, and rash, and patients should complete the full course even if symptoms improve quickly to prevent recurrence and complications. In more severe cases, such as necrotizing fasciitis, penicillin plus clindamycin is recommended for treatment of documented group A streptococcal infections 1. It's also important to note that empiric antibiotic treatment should be broad, covering both aerobic and anaerobic microbes, as the etiology can be polymicrobial or monomicrobial 1. Overall, the key to effective treatment is prompt initiation of appropriate antibiotic therapy, based on the severity and type of infection, and adjustment of treatment as needed based on culture results and clinical response.

From the FDA Drug Label

In streptococcal infections, therapy must be sufficient to eliminate the organism (ten-day minimum): otherwise the sequelae of streptococcal disease may occur. Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy.

Augmentation with antibiotics such as penicillin or azithromycin can cover Streptococcal (strep) infections, but the effectiveness depends on the specific strain and susceptibility of the bacteria 2, 3, 3.

• Penicillin is often the first-line treatment for strep infections.
• Azithromycin can be used as an alternative in individuals who cannot use first-line therapy. It is essential to note that antibiotic resistance is a concern, and susceptibility tests should be performed to ensure the chosen antibiotic is effective against the specific strain of strep bacteria.

From the Research

Antibiotic Augmentation for Streptococcal Infections

• The effectiveness of antibiotic augmentation in covering Streptococcal (strep) infections depends on various factors, including the type of antibiotic used and the specific strain of the bacteria 4, 5.
• Studies have shown that certain antibiotics, such as penicillin and amoxicillin, are effective in treating streptococcal pharyngitis, a common infection caused by group A beta-hemolytic streptococci 6, 7.
• However, the increasing resistance of streptococcal strains to certain antibiotics, such as clindamycin and erythromycin, has raised concerns about the effectiveness of these treatments 4, 5.
• Research has also explored the use of alternative antibiotics, such as linezolid, as adjunctive agents in the treatment of severe streptococcal infections, including necrotizing soft tissue infections and toxic shock syndrome 4.
• The choice of antibiotic regimen for streptococcal toxic shock syndrome (STSS) in children is critical, with studies suggesting that penicillin-containing regimens exhibit high efficacy rates, while macrolides and unused antibiotics show limited effectiveness 5.

Treatment Options for Streptococcal Infections

• Penicillin and amoxicillin are commonly recommended as first-line treatments for streptococcal pharyngitis, with a recommended course of 10 days 6, 7.
• First-generation cephalosporins are recommended for patients with non-anaphylactic allergies to penicillin 6, 7.
• Clindamycin and intravenous immunoglobulins may be used as adjunctive therapies in the treatment of severe streptococcal infections, including STSS 4, 5.
• The use of steroids is not recommended for symptomatic treatment of streptococcal pharyngitis 7.