Streptococcal Infections - Treatment

What was the treatment for your streptococcal disease?

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What is the treatment for invasive group A streptococcal disease?

Antibiotics treat invasive GAS infections as well as noninvasive GAS infections. Although many antibiotics may be adequate treatment for GAS infections, the best practice methods would be to determine antibiotic sensitivity of GAS bacteria to be sure the bacteria are susceptible to the antibiotics. Milder infections caused by GAS (strep throat, skin infections) are often treated with oral antibiotics (for example, penicillin V [Pen-Vee-K, Veetids], amoxicillin [Amoxil, Dispermox, Trimox], cephalosporins; if allergic to penicillins, erythromycin [E-Mycin, Eryc, Ery-Tab, Pce, Pediazole, Ilosone], azithromycin [Zithromax, Zmax]). Some third-generation cephalosporins (for example, ceftriaxone [Rocephin]), given IV or IM, followed by oral antibiotics are useful to treat mild to moderate infections. However, invasive GAS infections require a more aggressive treatment approach. High doses of penicillin, together with clindamycin (Cleocin) by sequential IV administration, are often recommended. Some investigators suggest adding immune globulin to the multi-antibiotic treatment.

In addition to antibiotics, surgical intervention may be necessary to remove dead and dying tissue to limit the spread of invasive GAS organisms. This is almost always done in patients who develop necrotizing fasciitis. In addition, early diagnosis and treatment of invasive GAS infections yield the best patient outcomes. Many clinicians consult with an infectious-disease specialist to help determine the best antibiotic therapy for individual patients. More GAS strains are being reported to have some resistance to one or more antibiotics so the treatment may require alterations in antibiotics. The infectious-disease specialist can help choose the most effective antibiotic combinations to treat antibiotic-resistant GAS organisms.

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