What is the treatment for Streptococcus (Strep) group G cellulitis?

From the Guidelines

The treatment for Group G Streptococcal cellulitis typically involves a course of antibiotics, with the first-line treatment being penicillin or amoxicillin for 5 days, as recommended by the most recent guidelines 1. The choice of antibiotic should be active against streptococci, and in cases where there is a high suspicion of methicillin-resistant Staphylococcus aureus (MRSA), coverage against this pathogen should be considered.

• For patients without penicillin allergies, penicillin V 500 mg orally four times daily or amoxicillin 500 mg three times daily can be used.
• For patients with penicillin allergies, alternatives include clindamycin 300-450 mg orally four times daily or a first-generation cephalosporin like cephalexin 500 mg orally four times daily if the allergy is not severe.
• In more severe cases requiring hospitalization, intravenous antibiotics such as penicillin G 2-4 million units every 4-6 hours or ceftriaxone 1-2 g daily may be necessary. Supportive care is also important, including elevation of the affected area, warm compresses, and pain management.
• Patients should complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence and complications.
• Group G Streptococcus responds well to penicillins because these bacteria, like other streptococci, are generally unable to develop resistance to beta-lactam antibiotics due to their cell wall structure and lack of beta-lactamase production, as noted in the guidelines 1.

From the FDA Drug Label

Skin and Skin Structure Infections: Due to S. aureus (including beta-lactamase-producing strains), S. pyogenes, and other strains of streptococci. The treatment for Streptococcus (Strep) group G cellulitis may include cefazolin (IV), as it is effective against other strains of streptococci. However, it is essential to perform appropriate culture and susceptibility studies to determine the susceptibility of the causative organism to cefazolin 2.

From the Research

Treatment for Streptococcus (Strep) Group G Cellulitis

• The treatment for Streptococcus (Strep) group G cellulitis typically involves antibiotic therapy, with the goal of eliminating the infection and preventing further complications 3, 4, 5.
• According to a study published in 2005, clindamycin may be effective in treating group G beta-haemolytic streptococcal infections, particularly in cases where treatment with high-dose penicillin has failed 4.
• Another study published in 2014 reported that antibiotic therapy based on antibiogram quickly resolved the infection, and a regimen of intramuscular injection of 1.2 million units of benzathine penicillin every 15 days for one year prevented recurrences of cellulitis 3.
• A review of 37 cases of invasive group G streptococcal infections found that all isolates were susceptible to penicillin, oxacillin, cefazolin, clindamycin, and vancomycin, suggesting that these antibiotics may be effective in treating group G streptococcal infections 5.

Antibiotic Therapy

• The choice of antibiotic therapy for group G streptococcal cellulitis may depend on various factors, including the severity of the infection, the presence of underlying diseases, and the results of antibiogram testing 3, 4, 5.
• A study published in 2016 found that beta-hemolytic streptococci, including group G streptococci, were the dominant cause of cellulitis in all clinical subgroups, and that penicillin response or beta-hemolytic streptococcal culture from skin swabs was associated with probable beta-hemolytic streptococcal infection 6.

Clinical Considerations

• Underlying host factors, such as immunosuppression, malignancy, diabetes mellitus, and rheumatoid arthritis, may be predisposing conditions leading to group G streptococcal infections 3, 5.
• Clinical improvement after therapy is often fast, but poor response to antibiotics should prompt investigation of underlying diseases or undrained foci of infection 5.