From the Research
For persistent vaginal GAS in children, I recommend a 10-day course of oral penicillin or amoxicillin as the first-line treatment, based on the most recent and highest quality study available 1.
Treatment Options
- Oral penicillin (such as penicillin V potassium 250-500 mg twice daily depending on weight)
- Amoxicillin (20-40 mg/kg/day divided into three doses, maximum 500 mg per dose)
Alternative Treatments
- For penicillin-allergic patients, clindamycin (10-30 mg/kg/day divided into three doses) or a macrolide like azithromycin (12 mg/kg once daily for 5 days, maximum 500 mg) are appropriate alternatives.
Recurrent Infection Considerations
- In cases of recurrent infection, consider adding rifampin (20 mg/kg/day divided into two doses, maximum 600 mg daily) for the last 4 days of treatment to enhance eradication, as suggested by previous studies 2.
Additional Considerations
- Persistent cases may require evaluation of household contacts who might be asymptomatic carriers, as reinfection from family members is common.
- Good hygiene practices are essential, including daily bathing, wearing cotton underwear, wiping front to back after toileting, and avoiding bubble baths or irritating soaps.
- GAS vaginal infections persist because the organism can establish biofilms that protect it from antibiotics, or because reinfection occurs from carriers in close contact.
- In some cases, tonsils and pharynx may serve as reservoirs for reinfection, so consider throat cultures in persistent cases, as recommended by recent guidelines 3, 1.
- If symptoms continue despite multiple treatment attempts, further evaluation for alternative diagnoses or underlying conditions may be necessary.