From the Guidelines
Perianal streptococcal infection should be treated with oral antibiotics, specifically penicillin or amoxicillin, for 10 days, as this approach has been shown to effectively eradicate the infection and prevent complications 1. The recommended dosage for adults is amoxicillin 500mg three times daily, while children should receive 50mg/kg/day divided into three doses (maximum 1500mg daily) 1. For penicillin-allergic patients, alternatives include clindamycin (300mg three times daily for adults; 30mg/kg/day divided into three doses for children) or a first-generation cephalosporin if the allergy is not severe 1. Some key points to consider when treating perianal streptococcal infection include:
- Topical mupirocin ointment can be used as an adjunct therapy but should not replace oral antibiotics
- Symptoms typically include perianal redness, pain, itching, and sometimes blood-streaked stools
- Diagnosis is confirmed by bacterial culture from the affected area
- Patients should complete the full antibiotic course even if symptoms improve quickly to prevent recurrence
- Good hygiene practices are essential during treatment, including gentle cleansing with mild soap and water after bowel movements and changing underwear daily
- The infection is caused by group A beta-hemolytic streptococci, the same bacteria responsible for strep throat, and requires systemic treatment to fully eradicate the infection and prevent complications 1. It's worth noting that while there are various treatment options available, the most effective approach is to use oral antibiotics, and penicillin or amoxicillin are the preferred choices due to their efficacy and safety profile 1.
From the Research
Treatment for Perianal Streptococcal (Strep) Infection
The treatment for Perianal Streptococcal (Strep) infection typically involves the use of antibiotics. The following points highlight the treatment approaches:
- Antibiotics such as amoxicillin or penicillin are effective in treating Perianal Streptococcal dermatitis, as stated in 2.
- Systemic antibiotics like penicillin, erythromycin, or newer macrolides, possibly combined with topical antiseptic or antibiotic ointments, are recommended, according to 3.
- The treatment duration should be at least 14 days, but 21 days is considered more effective, with the goal of achieving both clinical and microbiological cure, as suggested in 3.
- Oral phenoxymethylpenicillin (40-50 mg/kg/day) for 10 days is also an effective treatment, as reported in 4.
- In adults, antibiotics are prescribed according to the organism's sensitivity, and additional concomitant anorectal disease is treated following standard guidelines, as mentioned in 5.
- A 7-day oral amoxicillin regimen can also be effective in treating Perianal Streptococcal dermatitis, as seen in 6.
Key Considerations
Some key considerations in the treatment of Perianal Streptococcal (Strep) infection include:
- The importance of confirming the diagnosis through a rapid streptococcal test or skin culture, as noted in 2 and 3.
- The need for follow-up to monitor for recurrences, as mentioned in 2 and 3.
- The potential for Perianal Streptococcal dermatitis to be caused by different groups of Streptococci, such as group B in adults, as reported in 5.