Fast Five Quiz: Streptococcal Infection Clinical Keys

Michael Stuart Bronze, MD

Disclosures

February 18, 2021

Physicians must be aware and concerned about the potential for life-threatening complications presented by infection with GAS. Even seemingly minor infections (eg, pharyngitis, impetigo) may lead to fatal toxic shock syndrome.

Streptococcal impetigo is treated with oral antibiotics (eg, penicillin or azithromycin) for 10 days. However, because concomitant Staphylococcus aureus infection may occur, therapy with cephalexin or cefaclor is recommended.

Therapy for streptococcal pharyngitis is aimed primarily at preventing nonsuppurative and suppurative complications and decreasing infectivity. A 10-day course of penicillin V 250 mg twice daily in children and 500 mg twice daily or 250 mg 4 times daily in adults is very effective. Adjunctive therapy with a corticosteroid is not routinely recommended. In patients with penicillin allergy, a cephalosporin or azithromycin may be an appropriate alternative treatment.

IVIG has been reported to be efficacious as an adjunctive therapy in patients with GAS toxic shock syndrome. IVIG also has been reported to be beneficial in severe cases of staphylococcal toxic shock syndrome.

Treatment of necrotizing fasciitis consists of antibiotic therapy, supportive therapy for associated shock, and prompt surgical intervention. GAS remains sensitive to beta-lactam antibiotics. Clinical failure of penicillin therapy for streptococcal infections may occur. The failure rates are higher in patients with invasive infections because of the larger number of organisms.

Clindamycin may be more effective in invasive infections. Unlike penicillin, the efficacy of clindamycin is unaffected by the size of the inoculum and the stage of bacterial growth. In addition, clindamycin inhibits the production of toxins by streptococci.

Read more about the treatment of GAS infections.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases article Group A Streptococcal Infections.

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