Treatment of Group A Streptococcal Infections
| Infection | Treatmenta |
|---|---|
| Pharyngitis | Benzathine penicillin G (1.2 mU IM) or penicillin V (250 mg PO tid or 500 mg PO bid) × 10 days |
| (Children <27 kg: Benzathine penicillin G [600,000 units IM] or penicillin V [250 mg PO bid or tid] × 10 days) | |
| Impetigo | Same as pharyngitis |
| Erysipelas/cellulitis | Severe: Penicillin G (1-2 mU IV q4h) |
| Mild to moderate: Procaine penicillin (1.2 mU IM bid) | |
| Necrotizing fasciitis/myositis | Surgical debridement plus penicillin G (2-4 mU IV q4h) plus clindamycinb (600-900 mg IV q8h) |
| Pneumonia/empyema | Penicillin G (2-4 mU IV q4h) plus drainage of empyema |
| Streptococcal toxic shock syndrome | Penicillin G (2-4 mU IV q4h) plus clindamycinb (600-900 mg IV q8h) plus IV immunoglobulinb (2 g/kg as a single dose) |
aPenicillin allergy: A first-generation cephalosporin, such as cephalexin or cefadroxil, may be substituted for penicillin in cases of penicillin allergy if the nature of the allergy is not an immediate hypersensitivity reaction (anaphylaxis or urticaria) or another potentially life-threatening manifestation (e.g., severe rash and fever). Alternative agents for oral therapy are erythromycin (10 mg/kg PO qid, up to a maximum of 250 mg per dose) and azithromycin (a 5-day course at a dose of 12 mg/kg once daily, up to a maximum of 500 mg/d). Vancomycin is an alternative for parenteral therapy.
bEfficacy unproven, but recommended by several experts. See text for discussion.