This article is more than 5 years old. Information may no longer be current.
Clindamycin reduced mortality in severe group A streptococcal infections
Treatment with clindamycin may reduce the mortality associated with severe invasive group A streptococcal infections, researchers from the Telethon Institute for Child Health Research at the University of Western Australia in Perth have found.
They also suggest that concurrent treatment with IV immunoglobulin may enhance the effect of clindamycin.
“Patients with severe [invasive group A streptococcal] disease who received clindamycin were half as likely to die despite having more severe disease as measured by the presence of [streptococcal toxic shock syndrome] or necrotizing fasciitis, admission to an intensive care unit, or length of stay,” the researchers wrote in Clinical Infectious Diseases. “The fatality rate was lower still in the patients who were also treated with [IV immunoglobulin]. However, due to the unavoidably low number of cases, this failed to reach statistical significance.”
The researchers conducted prospective, active population-based surveillance of invasive group A streptococcal infections from March 2002 to August 2004 in Victoria, Australia. They identified 84 cases, which included patients with streptococcal toxic shock syndrome, necrotizing fasciitis, septic shock or group A streptococcal cellulitis. Fifty-three patients were treated with clindamycin; 14 of whom also received IV immunoglobulin.
In a univariate analysis, clindamycin treatment, with and without IV immunoglobulin, was associated with reduced case-fatality rate. In a multivariate analysis, this did not remain statistically significant (OR=0.31; 95% CI, 0.09-1.12). The researchers also found an association between clindamycin with IV immunoglobulin and reduced case-fatality rate, but this was not significant (OR=0.12; 95% CI, 0.01-1.29).
When evaluating the risk for invasive group A streptococcal infections among household contacts of the patients, the researchers identified three secondary cases. They estimated the number of household contacts to be 668, with an attack rate of 5,468 secondary cases per 100,000 person-years at risk. Compared with the risk for the general population, the incidence rate ratio for the household contacts was 2,011 (95% CI, 413-5,929).
“It is not known if this increased risk can be reduced by providing prophylactic antibiotics to household contacts, in the hope of eradicating carriage or treating early infection,” the researchers wrote. “Despite this uncertainty, given the rarity, severity and high case-fatality rate of [invasive group A streptococcal] disease, we believe prophylaxis is warranted for household contacts and poses little risk from the use of additional antibiotics.”
Disclosure: The researchers report no relevant financial disclosures.