From the Guidelines
Treatment for Streptococcus pyogenes skin infections typically involves oral antibiotics, with penicillin being the first-line treatment, and the most recent guidelines suggest a 5- to 6-day course of antibiotics active against streptococci for nonpurulent cellulitis, as recommended by the American College of Physicians in 2021 1.
Key Considerations
- For adults, penicillin V 500 mg orally four times daily is recommended, but the duration should be adjusted to 5-6 days based on the latest guidelines.
- For those allergic to penicillin, alternatives include clindamycin 300-450 mg orally three times daily for 5-6 days, or other options as suggested by the Infectious Diseases Society of America 1.
- For children, penicillin V 250-500 mg (based on weight) four times daily for 5-6 days is standard, considering the updated recommendations.
- In severe cases with rapidly spreading infection or systemic symptoms, intravenous antibiotics may be necessary, typically starting with penicillin G 2-4 million units every 4-6 hours, as indicated in the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections 1.
Additional Recommendations
- Proper wound care is essential, including keeping the area clean, applying topical antiseptics like chlorhexidine, and using sterile dressings if needed.
- Strep pyogenes is highly sensitive to penicillin because the bacteria cannot develop resistance to beta-lactam antibiotics, making these medications highly effective when taken for the full prescribed course.
- It's crucial to complete the entire antibiotic regimen even if symptoms improve quickly to prevent recurrence and complications, as emphasized in various guidelines and studies 1.
Important Considerations for Specific Patient Groups
- For outpatients with nonpurulent cellulitis, empirical therapy for infection due to b-hemolytic streptococci is recommended, with options including penicillin or clindamycin, as suggested by the Infectious Diseases Society of America 1.
- For hospitalized patients with complicated skin and soft-tissue infections, empirical therapy for MRSA should be considered pending culture data, with options including intravenous vancomycin, linezolid, or daptomycin, as recommended by the World Journal of Emergency Surgery in 2018 1.
From the FDA Drug Label
Infections of the Skin and Skin Structure:Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspp. (α-and β-hemolytic isolates only), Staphylococcusspp., or E. coli. It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenesto prevent the occurrence of acute rheumatic fever.
Treatment for Strep Pyogenes on Skin:
- Amoxicillin is indicated for the treatment of skin infections caused by Streptococcus pyogenes.
- The recommended treatment duration is at least 10 days to prevent acute rheumatic fever 2.
Uncomplicated skin and skin structure infections due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiae Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy
Alternative Treatment:
- Azithromycin can be used as an alternative treatment for uncomplicated skin and skin structure infections caused by Streptococcus pyogenes, especially in individuals who cannot use first-line therapy 3.
From the Research
Treatment Options for Strep Pyogenes on Skin
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid can be used to treat impetigo caused by Strep Pyogenes 4
- Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical, with options including amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides 4
- Cephalexin is an effective antibiotic for the treatment of streptococcal and staphylococcal skin infections, with cure rates of 90% or higher 5
- Penicillin remains the drug of choice for streptococcal skin infections, but alternative antibiotics such as cephalexin may be used if penicillin is not effective 5
Management Strategies
- Management of skin and soft tissue infections (SSTIs) caused by Group A Streptococcus (GAS) is challenging due to the risk of rapid progression and the risk of developing complications 6
- Proper recognition and treatment of GAS infections remain crucial to reduce high mortality rates 6
- The World Health Organization (WHO) has developed a GAS research and technology road map and has outlined preferred vaccine characteristics, stimulating renewed interest in the development of safe and effective GAS vaccines 7
Epidemiology and Pathogenesis
- GAS is responsible for a wide range of infections from mild disease to severe fatal invasive infections with high mortality rates 6
- GAS has the ability to produce a wide set of virulence factors which contribute to its pathogenicity and its ability to colonize different body sites and subsequently cause invasive infections 6
- Fluctuating global GAS epidemiology is characterized by the emergence of new GAS clones, often associated with the acquisition of new virulence or antimicrobial determinants 7