From the Research
Treatment for Group A Streptococcal (GAS) vaginal infection in children typically involves oral antibiotics, with penicillin being the first-line treatment, as supported by the most recent and highest quality study 1. The recommended regimen is oral penicillin V (phenoxymethylpenicillin) at 250-500 mg two to three times daily for 10 days, depending on the child's weight. For children allergic to penicillin, alternatives include erythromycin (20-40 mg/kg/day divided into 2-4 doses for 10 days), azithromycin (12 mg/kg once daily for 5 days, maximum 500 mg), or clindamycin (20-30 mg/kg/day divided into 3-4 doses for 10 days). Some key points to consider when treating GAS infections include:
- Completing the full course of antibiotics even if symptoms improve before completion to ensure complete eradication of the bacteria, as emphasized in a study on the management of invasive GAS infections 2.
- Maintaining good hygiene, wearing cotton underwear, avoiding irritants like bubble baths or scented soaps, and ensuring proper wiping technique (front to back) as supportive measures.
- The potential for complications such as scarlet fever or, rarely, rheumatic fever if left untreated, highlighting the importance of prompt treatment.
- The need for parents to contact a healthcare provider if symptoms worsen or don't improve within 48-72 hours of starting antibiotics, or if the child develops fever, rash, or appears significantly unwell. It's also worth noting that while other antibiotics like cephalosporins and macrolides may be effective, the evidence is not strong enough to recommend them as first-line treatments over penicillin, as discussed in a Cochrane review 1. Additionally, a study on the management of contacts of patients with severe invasive GAS infection suggests that targeted antibiotic prophylaxis may be effective in preventing additional cases, but more research is needed to confirm this 3. Overall, the treatment of GAS vaginal infections in children should prioritize penicillin as the first-line treatment, with careful consideration of alternative antibiotics and supportive measures to ensure the best possible outcomes.