From the Guidelines
For a patient with strep throat, diabetes, and a skin infection, the recommended first-line treatment is penicillin V potassium (phenoxymethylpenicillin) 500 mg orally twice daily for 10 days, as it is effective against Group A Streptococcus and has a narrow spectrum that minimizes disruption to normal flora 1. The presence of diabetes requires careful monitoring of blood glucose levels during the infection and treatment period, as infections can cause glucose fluctuations. The skin infection may require additional antibiotic coverage depending on its severity and causative organism. If the skin infection is also streptococcal, the same antibiotic may treat both conditions, but if it's caused by Staphylococcus or other bacteria, broader coverage with dicloxacillin, cephalexin, or trimethoprim-sulfamethoxazole may be necessary, with clindamycin being a suitable option for coverage against both streptococci and CA-MRSA 1. Some key points to consider in the treatment of skin and soft tissue infections include:
- Cultures of blood or cutaneous aspirates, biopsies, or swabs are not routinely recommended, but may be considered in certain cases 1
- Typical cases of cellulitis without systemic signs of infection should receive an antimicrobial agent that is active against streptococci 1
- The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period 1
- Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended 1 It is essential to note that the treatment should be individualized based on the patient’s clinical response and the severity of the infection. Complete adherence to the full course of antibiotics is essential to prevent complications like rheumatic fever and to ensure complete eradication of the infection. In cases where the patient has a penicillin allergy, alternatives such as cephalexin or clindamycin may be used, with the choice of antibiotic depending on the severity of the allergy and the causative organism of the skin infection 1.
From the FDA Drug Label
For the following infections, a dosage of 500 mg may be administered every 12 hours: streptococcal pharyngitis, skin and skin structure infections, and uncomplicated cystitis in patients over 15 years of age. In the treatment of β-hemolytic streptococcal infections, a therapeutic dosage of cephalexin should be administered for at least 10 days
The patient with strep throat, diabetes, and a skin infection can be treated with Cephalexin (PO). The recommended dosage is 500 mg every 12 hours for streptococcal pharyngitis and skin and skin structure infections. The treatment should continue for at least 10 days 2.
- Key points:
- Drug: Cephalexin (PO)
- Dosage: 500 mg every 12 hours
- Duration: At least 10 days
- Note: The patient's diabetes and skin infection do not affect the choice of antibiotic for strep throat, but may require additional management.
From the Research
Treatment of Strep Throat in a Diabetic Patient with a Skin Infection
- The patient has strep throat, diabetes, and a skin infection, requiring careful consideration of the appropriate antibiotic treatment.
- According to the study 3, penicillin is the treatment of choice for strep throat due to its cost, narrow spectrum of activity, and effectiveness.
- However, the patient also has a skin infection, which may require a different antibiotic. The study 4 compared the outcomes of treating complicated skin and skin structure infections (cSSSI) caused by methicillin-resistant Staphylococcus aureus (MRSA) with linezolid versus vancomycin in diabetic and non-diabetic patients.
- The study 5 found that amoxicillin-clavulanic acid was effective in eliminating Streptococcus pyogenes from a mixed infection with Staphylococcus aureus, while amoxicillin alone was not.
- The study 6 compared different antibiotic treatments for group A streptococcal pharyngitis and found that cephalosporins may be more effective than penicillin in resolving symptoms, but the evidence was uncertain.
- The study 7 found that levofloxacin was effective in treating bacterial infections, including those caused by Streptococcus pneumoniae, but its use in treating strep throat is not well established.
Antibiotic Treatment Options
- Penicillin (10 days of oral therapy or one injection of intramuscular benzathine penicillin) is the treatment of choice for strep throat 3.
- Amoxicillin-clavulanic acid may be considered for the treatment of a mixed infection with Staphylococcus aureus 5.
- Cephalosporins may be considered as an alternative to penicillin for the treatment of strep throat, but the evidence is uncertain 6.
- Linezolid or vancomycin may be considered for the treatment of complicated skin and skin structure infections (cSSSI) caused by MRSA in diabetic patients 4.