Group A beta hemolytic streptococci

When treatment is initiated before definitive culture and sensitivity results are known, consider that these agents are only effective in the treatment of infections caused by pneumococci, group A beta-hemolytic streptococci, and penicillin G-resistant and penicillin G-sensitive staphylococci. 

Treat Group A beta-hemolytic streptococci infections for at least 10 days. 

Mupirocin is not related to any of the sys-temically used antibiotics. It is an inhibitor of bacterial protein synthesis and is especially active against gram-positive aerobic bacteria, e.g. methicillin-resistant S. aureus and group A beta-hemolytic streptococci. Absorption through the skin is minimal. Intranasal application may be associated with irritation of mucous membranes. 

Mupirocin (pseudomonic acid A) is structurally unrelated to other currently available topical antibacterial agents. Most gram-positive aerobic bacteria, including methicillin-resistant S aureus, are sensitive to mupirocin. It is effective in the treatment of impetigo caused by S aureus and group A beta-hemolytic streptococci. 

Cellulitis results when the integrity of the skin is broken due to an abrasion, ulceration, skin puncture, or surgical wound. Moderate to severe infections can progress to more serious infections such as osteomyelitis if not adequately treated. Cellulitis is most commonly caused by group A beta-hemolytic streptococci (Streptococcus pyogenes) and Staphylococcus aureus. Wound cultures have a very low yield and rarely identify the causative pathogen. Thus, cultures are rarely done and therapy is usually presumptive. 

Rasmussen JE. The relationship between infection with group A beta hemolytic streptococci and the development of psoriasis. Pediatr Infect DisJ 2000 19 153-154. 

Kaplan EL, Johnson DR, del Rosario MC, et al. Susceptibility of group A beta-hemolytic streptococci to thirteen antibiotics Examination of 301 strains isolated in the United States between 1994 and 1997. Pediatr Infect Dis J 1999 18 1069-1072. 

Troleandomycin, a macrolide antibiotic (250 to 500 mg p.o. q. 6 hours), is used in pneumonia or respiratory tract infection caused by sensitive pneumococci or group A beta-hemolytic streptococci. 

Brook, 1. (2001). Failure of penicillin to eradicate group A beta-hemolytic streptococci tonsillitis Cause and management. /. Otolaryngol. 30,324r-329. 

In fasciitis or necrotizing infections caused by beta-hemolytic streptococci of group A, parenteral high-dose penicillin combined with clindamycin is the treatment of choice. For the treatment of abscesses, antibiotics which are able to kill large quantities of resting bacteria, such as clindamycin and the quinolones, are preferred. 

---