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Antibiotic management of suspected or confirmed invasive Group A Streptococcus (iGAS) infection in children

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The purpose of this guidance is to direct the antimicrobial management of suspected or confirmed invasive Group A Streptococcus (iGAS) infections in children presenting to the Royal Hospital for Children, Glasgow.

Diagnosis and wider clinical management are not within the scope of this guidance.

For the management of suspected non-invasive GAS infection please continue to use guidance issued by the Scottish Antimicrobial Prescribing Group (SAPG) – accessed via Paediatric Stewardship and that issued by NHS GG&C – accessed via Antibiotic management of Group A Streptococcus (GAS, Strep. pyogenes) infection in children.

The UKHSA and PHS have reported on an unusually high number of children presenting with lower respiratory tract GAS infection, including pulmonary empyema. A large proportion of cases have indicated co-infection with respiratory viruses including RSV, influenza, human metapneumovirus (hMPV) and enterovirus.

Increased case numbers of GAS and invasive Group A streptococcus infection (iGAS) have placed an unprecedented pressure on the medication supply chain. Alternative antibiotic management choices, and practical advice on the use of solid oral dosage forms is included within this guidance.

Isolates of GAS reported within NHS GGC have demonstrated good susceptibility to penicillin and macrolide antibiotics.

Editorial Information

Last reviewed: 01 December 2022

Next review: 31 March 2023

Author(s): Susan Kafka

Version: 4

Approved By: Antimicrobial Utilisation Committee