From the Guidelines
Group A Streptococcus (GAS) wound infections should be treated with penicillin or amoxicillin for 10 days in patients without penicillin allergy.
Treatment Options
- For patients without penicillin allergy, penicillin (250 mg 4 times daily or 500 mg twice daily) or amoxicillin (50 mg/kg once daily, max 1000 mg) for 10 days are recommended 1.
- For patients with penicillin allergy, cephalexin (20 mg/kg/dose twice daily, max 500 mg/dose), clindamycin (7 mg/kg/dose 3 times daily, max 300 mg/dose), or azithromycin (12 mg/kg once daily, max 500 mg) for 10 days are alternative options 1.
Special Considerations
- In cases of necrotizing fasciitis or streptococcal toxic shock syndrome, clindamycin and penicillin should be used in combination, as clindamycin suppresses streptococcal toxin and cytokine production 1.
- The choice of antibiotic should be guided by local resistance patterns and susceptibility testing, if available.
Duration of Treatment
- The recommended duration of treatment is 10 days, which is likely to eradicate the organism from the wound 1.
From the Research
Antibiotic Treatment for Group A Streptococcus (GAS) Wound Infections
- The primary antibiotic treatment for GAS infections, including wound infections, is penicillin and other β-lactams, as GAS has remained susceptible to these antibiotics despite their widespread use for 80 years 2.
- According to a study published in 2021, all GAS isolates were susceptible to β-lactams, indicating that these antibiotics are effective against GAS wound infections 3.
- Another study from 1982 reported that penicillin was used to eradicate GAS colonization in a nurse who was a carrier of the bacteria, highlighting the effectiveness of penicillin in treating GAS infections 4.
- A review of GAS infections published in 2011 noted that oral penicillin V is the antibiotic treatment of choice for GAS pharyngitis due to its efficacy, safety, and narrow spectrum, and this may also apply to wound infections 5.
- However, some studies suggest that antibiotic prophylaxis may not be necessary for preventing GAS wound infections in certain cases, such as in burn patients who receive early excision and closure of deep wounds 6.
Considerations for Antibiotic Treatment
- The choice of antibiotic treatment for GAS wound infections should consider local resistance patterns, as the prevalence of erythromycin-nonsusceptible and clindamycin-nonsusceptible strains can vary by region 3.
- Clinicians should be aware of the potential for antibiotic failure in treating GAS infections, particularly in cases where the bacteria have developed reduced susceptibility to β-lactams or other antibiotics 2.
- Adjunctive therapies may be necessary to improve treatment outcomes for high-risk GAS infections, and further research is needed to understand the mechanisms of antibiotic failure and to develop effective treatment strategies 2.