Antibiotic Coverage for Group A Streptococcus and MRSA Skin Infections
First-line Options
- The Infectious Diseases Society of America recommends Clindamycin (300-450 mg PO TID for adults; 10-13 mg/kg/dose PO every 6-8 hours, not to exceed 40 mg/kg/day for children) as the preferred single agent that effectively covers both GABHS and MRSA 1, 2
- For combination therapy, the Infectious Diseases Society of America suggests TMP-SMX or a tetracycline (doxycycline/minocycline) plus amoxicillin can be used to cover both pathogens 1, 2
Inpatient Treatment
- The Infectious Diseases Society of America recommends Vancomycin IV (15-20 mg/kg/dose every 8-12 hours) for inpatient treatment of complicated infections 2, 3
- Clindamycin IV (600 mg every 8 hours) is also recommended for inpatient treatment of complicated infections 2, 3
Antimicrobial Selection Considerations
- The Infectious Diseases Society of America notes that Clindamycin provides excellent coverage against both GABHS and MRSA in a single agent 2
- The Infectious Diseases Society of America suggests that TMP-SMX or tetracyclines (doxycycline/minocycline) plus a beta-lactam (amoxicillin) can be used as an alternative to Clindamycin 1, 2, 4
Important Clinical Considerations
- The Infectious Diseases Society of America recommends monitoring local resistance patterns for clindamycin, as resistance rates are increasing in some areas 4
- The Infectious Diseases Society of America suggests performing D-zone testing for inducible clindamycin resistance when using for serious infections 5
- The Infectious Diseases Society of America recommends considering obtaining cultures from abscesses and purulent SSTIs to guide therapy 1