Antibiotics | Prophylaxis in Invasive GAS Infections in Pediatrics

This study investigates the clinical practices of Italian pediatric infectious disease experts through a survey, revealing treatment variations and uncertainties in managing invasive Group A Streptococcus infections. It provides critical insights for future guideline development to standardize pediatric iGAS infection management.

 

Literature Overview
This article, '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 the current treatment approaches and prevention strategies for invasive Group A Streptococcus (GAS) infections among Italian pediatric infectious disease specialists. It highlights the diversity in clinical decision-making due to the lack of unified guidelines.

Background Knowledge
Group A Streptococcus (GAS) is a common pathogen that can cause severe invasive infections (e.g., necrotizing fasciitis, streptococcal toxic shock syndrome) in children. The management of iGAS infections remains challenging, including rising antibiotic resistance, indications for combination therapy, and standardized use of supportive treatments (e.g., IVIG and corticosteroids). Current recommendations for chemoprophylaxis in high-risk contacts vary significantly across countries, with limited high-quality evidence from large-scale clinical trials. This study aims to address these gaps and guide future guideline development and clinical research.

 

 

Research Methods and Experiments
The study employed a web-based questionnaire designed according to the CROSS checklist, containing 62 questions across 11 major topics, including treatment regimens for different infection types, use of supportive therapies, and prophylactic strategies for contacts. The survey was distributed to 73 pediatric infectious disease specialists, with 24 complete responses (32.8% response rate).

Key Conclusions and Perspectives

• Over 75% of experts recommend beta-lactam antibiotics (e.g., penicillin, ceftriaxone) as first-line therapy, but significant discrepancies exist regarding combination antibiotic strategies.
• For streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis (NF), most experts support early addition of clindamycin or linezolid, though consensus on discontinuation timing for combination therapy remains lacking.
• Linezolid shows higher preference than clindamycin for brain abscess management, with a switch to monotherapy considered upon significant lesion reduction confirmed by MRI.
• Clinical application of IVIG and corticosteroids demonstrates substantial variability, particularly lacking uniform standards for non-STSS/NF infections.
• While chemoprophylaxis is broadly endorsed for high-risk groups (e.g., immunosuppressed individuals, recent surgical patients, neonates, pregnant women), standardization of specific regimens and timing is still required.

Research Significance and Prospects
This study underscores the urgent need for unified guidelines in managing invasive GAS infections, especially for combination antibiotics, immunomodulatory therapies, and contact prophylaxis. Future research should focus on clinical outcomes of different treatment protocols, optimal timing for anti-toxin antibiotics, and comparative safety/efficacy of clindamycin versus linezolid in pediatric populations.

 

 

Conclusion
The study reveals significant practice variations in combination therapy, supportive care, and contact prophylaxis despite relative consensus on first-line antibiotic use for iGAS infections. This highlights the necessity for multicenter research to evaluate treatment effectiveness and establish national standardized management protocols to improve pediatric iGAS care.

 

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.