What is the treatment for recurrent perianal streptococcal (strep) infections?

From the Guidelines

The treatment for recurrent perianal streptococcal infections should involve a 10-14 day course of oral antibiotics, such as amoxicillin 50 mg/kg/day divided into three doses, with consideration of household decolonization measures and proper hygiene practices to prevent reinfection. The choice of antibiotic should be guided by culture results, if available, and consideration of the patient's allergy history 1. For penicillin-allergic patients, alternatives such as clindamycin or a first-generation cephalosporin may be used 1. It is essential to note that recurrent abscesses should be drained and cultured early in the course of infection to guide antibiotic therapy 1. Additionally, adult patients with recurrent abscesses should be evaluated for underlying conditions such as neutrophil disorders 1.

Some key considerations in the treatment of recurrent perianal streptococcal infections include:

• The use of a 5- to 10-day course of an antibiotic active against the pathogen isolated from culture results 1
• Consideration of a decolonization regimen, including intranasal mupirocin, daily chlorhexidine washes, and daily decontamination of personal items, although this is more relevant for recurrent S. aureus infections 1
• The importance of proper hygiene practices, including thorough handwashing, keeping the perianal area clean and dry, and avoiding scratching, to prevent reinfection 1
• The potential need for consultation with an infectious disease specialist in cases of multiple recurrences despite appropriate therapy to consider more aggressive management strategies 1.

In terms of specific antibiotic dosages, the guidelines recommend:

• Amoxicillin 50 mg/kg/day divided into three doses for 10-14 days (maximum 1500 mg daily) for non-allergic patients
• Clindamycin 30 mg/kg/day divided three times daily (maximum 900 mg daily) or a first-generation cephalosporin for penicillin-allergic patients 1.

It is crucial to prioritize the patient's quality of life, morbidity, and mortality when making treatment decisions, and to consider the most recent and highest-quality evidence available 1.

From the FDA Drug Label

Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci In cases of β-hemolytic streptococcal infections, treatment should continue for at least 10 days.

The treatment for recurrent perianal streptococcal (strep) infections is clindamycin. The dosage is:

• Adults: 150 to 300 mg every 6 hours for serious infections, and 300 to 450 mg every 6 hours for more severe infections.
• Pediatric Patients: 8 to 16 mg/kg/day divided into three or four equal doses for serious infections, and 16 to 20 mg/kg/day divided into three or four equal doses for more severe infections. Treatment should continue for at least 10 days in cases of β-hemolytic streptococcal infections 2 2.

From the Research

Treatment for Recurrent Perianal Streptococcal Infections

The treatment for recurrent perianal streptococcal infections typically involves antibiotic therapy. According to the studies, the following points are relevant:

• A study published in 2011 found that perineal streptococcal dermatitis initially treated with penicillin or amoxicillin is consistently associated with a high risk of clinical recurrence 3.
• Another study from 2008 reported that one course of systemic antibiotic treatment augmented by additional local antiseptic ointment in selected cases cured all patients with perianal streptococcal dermatitis within 10 to 14 days 4.
• A 2013 study found that treatment with oral antibiotics according to the organism sensitivity resolved the condition in a high proportion of adult patients with perianal streptococcal dermatitis 5.
• A systematic literature review published in 2021 concluded that systemic antimicrobials (penicillin V, amoxycillin, or cefuroxime) are superior to topical treatment for perianitis in childhood 6.

Key Considerations

Some key considerations for the treatment of recurrent perianal streptococcal infections include:

• The choice of antibiotic therapy, with some studies suggesting that beta-lactamase resistant agents may be more effective in reducing the risk of recurrence 3.
• The importance of completing a full course of antibiotic treatment to ensure complete resolution of the infection.
• The potential for asymptomatic streptococcal throat carriage to contribute to the development of perianal streptococcal infections 6.
• The need for a high index of suspicion and prompt diagnosis to prevent prolonged discomfort and potential complications.

Treatment Options

Treatment options for recurrent perianal streptococcal infections may include:

• Oral antibiotics such as penicillin or amoxicillin 3, 4.
• Beta-lactamase resistant agents such as cefuroxime 6.
• Topical antiseptic ointment in addition to systemic antibiotic treatment 4.
• Treatment of any underlying anorectal conditions that may be contributing to the development of perianal streptococcal infections 5.