From the Research
Yes, neonates can get perianal streptococcal infection, though it is less common in this age group compared to children aged 6 months to 10 years. This infection is typically caused by group A beta-hemolytic streptococci (GAS) and presents with perianal erythema, pain, rectal bleeding, constipation, and sometimes fever. According to the most recent and highest quality study 1, the clinical presentation is distinctive and includes defecation disorders, perianal pain, local itch, rectal bleeding, or fissure and a sharply demarcated perianal redness.
Diagnosis and Treatment
Diagnosis is made through bacterial culture or rapid antigen detection test from a perianal swab. The recommended treatment for neonates with perianal streptococcal infection is oral penicillin V (25-50 mg/kg/day divided into 3-4 doses) for 10 days, as supported by 1. Alternatives for penicillin-allergic infants include erythromycin (30-50 mg/kg/day divided into 3-4 doses) or clindamycin (10-30 mg/kg/day divided into 3-4 doses).
Prevention of Complications
Prompt treatment is important to prevent complications such as cellulitis, abscess formation, or potential spread of infection. Parents should be advised to complete the full course of antibiotics even if symptoms improve quickly, maintain good perianal hygiene, and watch for signs of worsening infection such as increased redness, swelling, or fever. The infection occurs when streptococci colonize the perianal region, causing localized inflammation and discomfort, and can sometimes be associated with concurrent or recent streptococcal pharyngitis, as noted in 2.
Key Considerations
Key considerations in managing perianal streptococcal infection in neonates include:
- Early diagnosis and treatment to prevent complications
- Completion of the full course of antibiotics
- Maintenance of good perianal hygiene
- Monitoring for signs of worsening infection
- Awareness of the potential for recurrence, as noted in 2, with a recurrence rate of 12.4% after amoxicillin treatment.