Antibiotics | Prophylaxis in Invasive GAS Infections in Pediatrics

This article investigates clinical practices among Italian pediatric infectious disease specialists regarding invasive Group A Streptococcal infections, revealing treatment disparities and uncertainties. The findings provide critical insights for future clinical guideline development.

 

Literature Overview
This study, 'Current Clinical Practice on the Management of Invasive Streptococcus Pyogenes Infections in Children: A Survey-Based Study', published in the journal Antibiotics, reviews and summarizes current practices of Italian pediatric infectious disease specialists in managing invasive Group A Streptococcal (iGAS) infections, highlighting clinical decision variability in the absence of standardized guidelines.

Background Knowledge
Group A Streptococcus (GAS) is a common pathogen that can cause severe invasive infections such as necrotizing fasciitis and streptococcal toxic shock syndrome (STSS). In pediatric populations, management of iGAS infections presents multiple challenges, including rising antibiotic resistance, indications for combination therapy, and standardized use of supportive treatments like IVIG and corticosteroids. Current recommendations for chemoprophylaxis in high-risk contacts show significant international variation, with limited high-quality evidence from large clinical trials. This study aims to address these gaps and inform future guideline development and clinical research.

 

 

Research Methods and Experiments
The study employed a web-based questionnaire designed using the CROSS checklist, containing 62 questions across 11 key topics including treatment regimens for different infection types, supportive therapy protocols, and contact prophylaxis strategies. The survey was distributed to 73 pediatric infectious disease specialists, with 24 complete responses received (32.8% response rate).

Key Conclusions and Perspectives

• Over 75% of specialists recommend beta-lactam antibiotics (e.g., penicillin, ceftriaxone) as first-line therapy, though significant discrepancies exist regarding combination antibiotic use.
• For STSS and necrotizing fasciitis (NF), specialists generally support early addition of clindamycin or linezolid, but consensus remains lacking regarding discontinuation timing of combination therapy.
• Linezolid demonstrates higher support than clindamycin in brain abscess management, with monotherapy considered upon significant lesion reduction confirmed by MRI.
• IVIG and corticosteroid utilization shows substantial variability across clinical scenarios, particularly lacking standardized protocols for non-STSS/NF infections.
• While chemoprophylaxis is widely endorsed for high-risk groups (e.g., immunosuppressed individuals, recent surgical patients, neonates, pregnant women), specific regimens and timing require standardization.

Research Significance and Prospects
This study underscores the urgent need for standardized guidelines in iGAS infection management, particularly concerning combination antibiotics, immunomodulatory therapies, and contact prophylaxis strategies. Future research should prioritize comparative clinical outcomes, optimal timing for antitoxin antibiotics, and safety/efficacy comparisons between clindamycin and linezolid in pediatric populations.

 

 

Conclusion
While first-line antibiotic choices demonstrate relative consistency in iGAS infection management, significant practice variations persist in combination therapies, supportive treatments, and contact prophylaxis approaches. These findings emphasize the necessity for multicenter studies to evaluate treatment strategies and national standardization efforts to optimize pediatric iGAS care pathways.

 

Maia De Luca, Costanza Tripiciano, Carmen D’Amore, Claudia Colomba, and Andrea Lo Vecchio. Current Clinical Practice on the Management of Invasive Streptococcus Pyogenes Infections in Children: A Survey-Based Study. Antibiotics.