section name header

Information

Risk Assessment for Early-Onset Group B Streptococcal Disease Among Infants Born at >=35 Weeks of Gestation !!flowchart!!

mainimage

Treatment of GAS Pharyngitis

Drug

Dosage

Indication

Preferred

Penicillin V (oral)

  • <27 kg: 400,000 U (250 mg), 2–3 times per day, for 10 days
  • >=27 kg: 800,000 U (500 mg), 2–3 times per day, for 10 days
  • Drug of choice for treatment of
    GAS pharyngitis

Amoxicillin (oral)

  • 50 mg/kg (max, 1000–1200 mg), once daily, for 10 days
  • More palatable suspension than penicillin V

Second-Line Treatments for Specific Situations

Penicillin G benzathine (IM)

  • <27 kg: 600,000 U (375 mg) in a single dose
  • >=27 kg: 1.2 million U (750 mg) in a single dose
  • Concerns about adherence to daily therapy

Cephalexin (oral)

  • 25–50 mg/kg/day, divided into 2 doses
  • 10-day course
  • Nonanaphylactic allergy to penicillin

Clindamycin (oral)b

  • 20 mg/kg/day, divided into 3 doses (max, 900 mg/day),
    for 10 days
  • Immediate (anaphylactic) or type I
    hypersensitivity to penicillin

Erythromycina, b (oral) or 
clarithromycinb (oral)

  • Erythromycin: 40–50 mg/kg/day, divided into 3–4 doses,
    max 4 g per day
  • Clarithromycin: 15 mg/kg/day, divided into 2 doses,
    max 1 g per day
  • 10-day course
  • Allergy to penicillin

Azithromycin (oral)

  • 12 mg/kg/day for 1 day, followed by 6 mg/kg/day for an additional 4 days (max, 500 mg/day)
  • Allergy to penicillin

a Erythromycin is associated with substantially higher rates of gastrointestinal tract adverse effects compared with clarithromycin or azithromycin.

b Currently, up to 15% of group A streptococci may be resistant to clindamycin and the macrolides.

Techniques for Decolonization of Carriers of S aureus

Technique

Details

Effectiveness

Clothing and bed linens

  • Use items that promote cooling and minimize sweating
  • Unproven

Combination antimicrobials

  • 7-day course of oral rifampin and doxycycline plus nasal mupirocin
  • Give twice daily
  • Modestly successful in adults

Family decolonization

  • All family members apply mupirocin to the nares and bathe
    using chlorhexidine for 5 consecutive days
  • Associated with decreased recurrences

Skin hygiene

  • Practice appropriate wound care
  • Minimize skin trauma
  • Keep abrasions and cuts covered
  • Optimize hand hygiene
  • Shower after activities involving skin-to-skin contact
  • Unproven

Bleach bathsa

For dilute bleach baths:

  • Use 1 teaspoon per gallon of water (or 1/4 cup per 1/4 tub or
    13 gallons of water)
  • Bathe for 15 minutes twice weekly for approximately 3 months
  • Unproven

a Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):e18-e55