What is the treatment for Beta-hemolytic Streptococcus (BHS) group G with amoxicillin (amoxicillin)?

From the Guidelines

Amoxicillin is an appropriate treatment for Beta-hemolytic Streptococcus (BHS) group G infections, with a recommended dosage of 50 mg/kg once daily (max = 1000 mg) or 25 mg/kg (max = 500 mg) twice daily for 10 days, as supported by the Infectious Diseases Society of America guidelines 1.

Key Considerations

• The dosage for adults is typically 500 mg three times daily or 875 mg twice daily for 10 days, while for children, the dosage is usually 45-90 mg/kg/day divided into two or three doses.
• If the patient has a penicillin allergy, alternatives include clindamycin (300-450 mg four times daily for adults) or a macrolide such as azithromycin (500 mg on day 1, then 250 mg daily for 4 more days) 1.
• It's essential to complete the full course of antibiotics even if symptoms improve before completion to ensure complete eradication of the bacteria and prevent complications.

Rationale

• Group G streptococci are generally sensitive to beta-lactam antibiotics like amoxicillin because these medications inhibit bacterial cell wall synthesis.
• While Group G strep infections are typically less common than Group A, they can cause similar clinical manifestations, including pharyngitis, skin infections, and occasionally more serious conditions.
• Prompt treatment helps prevent potential complications such as post-streptococcal glomerulonephritis, though Group G strep rarely causes rheumatic fever.

Important Notes

• The Infectious Diseases Society of America guidelines emphasize the importance of accurate diagnosis and appropriate antimicrobial therapy to prevent complications and minimize the risk of antimicrobial resistance 1.
• The guidelines also highlight the need to exclude the diagnosis of GAS pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with nonstreptococcal pharyngitis.

From the FDA Drug Label

Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspecies. (α-and β-hemolytic isolates only)

The treatment for Beta-hemolytic Streptococcus (BHS) group G with amoxicillin is amoxicillin oral suspension, as it is indicated for the treatment of infections due to susceptible β-lactamase–negative isolates of Streptococcus species, including β-hemolytic isolates.

• The recommended dosage is:
  • For mild/moderate infections: 500 mg every 12 hours or 250 mg every 8 hours for adults, and 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours for pediatric patients.
  • For severe infections: 875 mg every 12 hours or 500 mg every 8 hours for adults, and 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours for pediatric patients.
• Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained 2.

From the Research

Treatment for Beta-hemolytic Streptococcus (BHS) group G with Amoxicillin

• The provided studies do not specifically address the treatment of Beta-hemolytic Streptococcus (BHS) group G with amoxicillin 3, 4, 5, 6, 7.
• However, study 7 evaluates the effectiveness of once-daily amoxicillin in the treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis, which may provide some insight into the use of amoxicillin for BHS infections.
• According to study 7, once-daily amoxicillin therapy is as effective as penicillin V therapy given three times a day for the treatment of GABHS pharyngitis.
• Study 5 mentions that first-line treatment for GABHS pharyngitis includes a 10-day course of penicillin or amoxicillin, but does not specifically address BHS group G.
• Study 6 discusses the treatment of beta-hemolytic streptococcal bacteremia in adults, including the use of clindamycin in combination with benzylpenicillin, but does not mention amoxicillin as a treatment option for BHS group G.

BHS Group G Treatment Considerations

• The studies provided do not offer specific guidance on the treatment of BHS group G with amoxicillin, and more research may be needed to determine the effectiveness of this treatment approach 3, 4, 5, 6, 7.
• It is essential to consult with a healthcare professional for proper diagnosis and treatment of BHS infections, as they can provide personalized guidance and recommendations based on the latest research and clinical guidelines.