From the Guidelines
Group A streptococcus (GAS) in the vagina of children is typically treated with oral antibiotics, with penicillin being the first-line treatment, as recommended by the Infectious Diseases Society of America 1. For children, amoxicillin is often prescribed at a dose of 50 mg/kg/day divided into two or three doses for 10 days, as it has been shown to be effective in treating group A streptococcal pharyngitis 1. The following key points should be considered:
- For penicillin-allergic patients, alternatives include clindamycin (20-30 mg/kg/day divided into three doses for 10 days) or a macrolide such as azithromycin (12 mg/kg once daily for 5 days) 1.
- It's essential to complete the full course of antibiotics even if symptoms improve before completion.
- Parents should ensure good hygiene practices, including proper front-to-back wiping after toileting and regular bathing.
- Medical evaluation is essential before treatment, as GAS in the vagina of prepubertal girls may indicate sexual abuse in some cases, though it can also occur through non-sexual transmission.
- Treatment is necessary to prevent complications such as local infections, scarlet fever, or rarely, more serious conditions like rheumatic fever or post-streptococcal glomerulonephritis.
- Follow-up testing after treatment completion may be recommended to ensure the infection has cleared.
From the FDA Drug Label
In streptococcal infections, therapy must be sufficient to eliminate the organism (ten-day minimum): otherwise the sequelae of streptococcal disease may occur.
The treatment for Group A streptococcal (GAS) infection is penicillin for a minimum of 10 days to eliminate the organism and prevent sequelae of streptococcal disease 2.
- The oral route of administration may be used, but it should not be relied upon in patients with severe illness or those who may not absorb therapeutic amounts of the drug.
- Cultures should be taken after completion of treatment to determine whether streptococci have been eradicated.
- It is essential to complete the full course of therapy as directed to ensure effectiveness and prevent the development of resistance.
From the Research
Treatment for Group A Streptococcal Infection
- The treatment for Group A streptococcal (GAS) infection in the vagina of children is primarily focused on antibiotic therapy, with penicillin being the most commonly recommended treatment 3.
- Penicillin therapy has been shown to result in prompt cure for GAS infections, including vulvovaginitis in prepubertal girls 3.
- Other antibiotics, such as cephalexin, have also been studied as potential treatments for GAS infections, and have been found to be effective in some cases 4.
- However, the emergence of antibiotic-resistant GAS strains has raised concerns about the effectiveness of current treatment options 5, 6.
- It is essential to note that the choice of antibiotic therapy may depend on various factors, including the severity of the infection, the patient's age and health status, and the presence of any underlying medical conditions.
Antibiotic Resistance
- GAS infections have been found to be susceptible to β-lactams, including penicillin, despite the widespread use of these antibiotics for over 80 years 6.
- However, the emergence of GAS strains with reduced susceptibility to β-lactams has been reported, highlighting the need for continued surveillance and monitoring of antibiotic resistance patterns 5, 6.
- The use of adjunctive therapies, such as clindamycin and macrolides, may be considered in cases where antibiotic resistance is suspected or confirmed 5, 6.
Diagnosis and Treatment Guidelines
- The diagnosis of GAS infections, including vulvovaginitis, typically involves the use of throat swabs or vaginal swabs, followed by culture and antibiotic susceptibility testing 3, 7.
- Treatment guidelines for GAS infections, including pharyngitis and vulvovaginitis, recommend the use of antibiotics, such as penicillin or amoxicillin, for patients with positive culture results 3, 7.