Table 1.
Guideline.
| Countries/Recommendations | IVIG | Clindamycin | Secondary prophylaxis |
|---|---|---|---|
| Common recommendations | None | None | • For all: inform close contacts • Seek medical attention promptly if symptoms occur • Antibiotics to close contacts if they present any symptoms of a localized infection with GAS (angina, fever, skin infection, etc.) (1, 10–13) |
| USA | Infection refractory to aggressive treatment or a non-drainable focus or an oliguria persistence with pulmonary oedema (14) | Severe GAS infection◦ (14) | • Chemoprophylaxis to household contacts who have a high risk of iGAS (age ≥ 65 years, HIV infection, diabetes, cancer, heart disease, addiction, corticosteroids, Native American origin), or death (10, 14) • Penicillin + rifampicin • Clindamycin • Azithromycin (10, 14) |
| Canada | Severe GAS infection◦ or infection refractory to aggressive treatment (15) | Severe GAS infectio◦ (15) | • Chemoprophylaxis to close contacts of a patient with a severe iGAS◦
• Chemoprophylaxis to close contacts if two or more cases occur in a community within 1 month • chemoprophylaxis to close contacts if a case in a child care center occurs at the same time as a chickenpox outbreak • 1st choice: 1st generation cephalosporins • If beta-lactams allergy: clindamycin or macrolides (15) |
| United Kingdom | No consensus | No consensus | • Chemoprophylaxis to a mother or her child if either has an iGAS during the neonatal period (the first 28 days of life) • Chemoprophylaxis to close contacts if two or more cases occur in a community within 1 month • 1st choice: oral penicillin • If beta-lactams allergy: azithromycin (12) |
| Ireland | STSS or NF if associated with organ failure (16) | Suspected severe infection◦ (16) | • Chemoprophylaxis to a mother or her child if either has an iGAS during the neonatal period (the first 28 days of life) • Chemoprophylaxis to close contacts if two or more cases occur in a community within 1 month • 1st choice: oral penicillin • If beta-lactams allergy: azithromycin (16) |
| France | STSS or NF | NF, STSS, or toxin signs (rash, digestive or hemodynamic disorders) (17) | • Chemoprophylaxis to close contacts at risk of iGAS or complications (age ≥ 65 years, chickenpox, extensive skin lesions (including burns), drug addiction, progressive pathology (diabetes, cancer, hematology, HIV infection, heart failure), oral corticosteroid treatment (defined as doses > 5 mg/kg/day prednisone for more than 5 days or doses equivalent to or >0.5 mg/kg/day prednisone for ≥30 days) • 1st choice: 2nd or 3rd generation cephalosporins • If beta-lactams allergy: clindamycin or macrolides • If macrolide-resistant GAS: oral penicillin + rifampin (13) |
| Australia | No consensus | No consensus | • Chemoprophylaxis to close contacts of patient with a severe iGAS◦
• Chemoprophylaxis to a mother or her child if either develops an iGAS in the neonatal period (the first 28 days of life) • Chemoprophylaxis to close contacts if two or more cases occur in a community within 3 months • 1st choice: benzathine penicillin (intramuscular) • 2nd choice if oral therapy preferred: cephalexin • If beta-lactams allergy: macrolides • If macrolide-resistant GAS or pregnant women: clindamycin (11) |
| Belgium (Flanders) | No consensus | No consensus | • Chemoprophylaxis to all household contacts of the index case • 1st choice: azithromycin • If macrolide-resistant GAS or pregnant women: clindamycin (18) |
| Our recommendations | All hemodynamically unstable patients and/or admitted to intensive care unit and/or having STSS or NF | For all hospitalized iGAS infections | • Chemoprophylaxis to all household members of the patient • Chemoprophylaxis to people at high risk of complications or deaths related to iGAS • 1st choice: first-generation cephalosporins • If beta-lactams allergy: macrolides • If macrolide-resistant GAS or pregnant women: clindamycin |
◦
Severe iGAS refers to iGAS such as pneumonia, meningitis, NF, STSS, or any manifestation requiring admission to intensive care or leading to death.