Background. Although Group A Streptococcus (GAS) is sensitive to penicillin, the mortality rate for invasive disease remains 20%, fuelling a search for additional therapies. Two approaches favoured by some specialists are adjunctive clindamycin and intravenous immunoglobulin (IVIG). Preclinical studies provide rationale for their use, but for clindamycin there have been no randomized controlled trials (RCT) and prospective series have not demonstrated clinical benefit; while the only RCT of IVIG was underpowered. Decisions about whether to prescribe these agents therefore depend on the opinion of the attending clinicans. Objective. To document the opinion of consultant microbiologists working within the NHS in the south west region of England regarding use of IVIG and clindamycin for invasive GAS. Method. All consultant microbiologists working in the NHS in the southwest region of England were contacted in 2011 and asked to complete a questionnaire regarding management of three clinical scenarios: (1) Streptococcal toxic shock syndrome (StrepTSS), (2) streptococcal necrotising fasciitis (NF), and (3) streptococcal empyema with bacteraemia. Results. 30 of 39 consultants completed the questionnaire. The proportion of respondents who indicated that they would recommend or consider recommending IVIG in each scenario were: 57% for StrepTSS, 45% for NF and 0% for empyema. The proportions who would recommend clindamycin were 97% for StrepTSS, 93% for NF and 62% for empyema. Conclusion. This review suggests that in StrepTSS and NF the majority of consultant microbiologists would recommend clindamycin, but they remain divided regarding use of IVIG. In the bacteraemic patient without shock (represented by the patient with empyema), none would consider IVIG, and there is no consensus regarding clindamycin use.
|Publication status||Accepted/In press - 19 Nov 2012|
|Event||Federation of Infection Societies 2012 - Liverpool, United Kingdom|
Duration: 19 Nov 2012 → 22 Nov 2012
|Conference||Federation of Infection Societies 2012|
|Period||19/11/12 → 22/11/12|