Initial therapy for uncomplicated Streptococcus pyogenes (group A streptococcus) bloodstream infections
Australian Commission on Safety and Quality in Health Care (ACSQHC), 2023
Patients have uncomplicated Streptococcus pyogenes bloodstream infection if they do not have sepsis, septic shock, toxic shock syndrome, pneumonia, meningitis or necrotising fasciitis. For patients with these complications, see Initial therapy for complicated Streptococcus pyogenes (group A streptococcus) bloodstream infections, including toxic shock syndrome.
For adults and children with uncomplicated S. pyogenes bloodstream infection, monotherapy is appropriate. Use:
benzylpenicillin 2.4 g (child 60 mg/kg up to 2.4 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment. See advice on continuation therapy. benzylpenicillin benzylpenicillin benzylpenicillin
For adults and children who have had a nonsevere (immediate or delayed) or a severe (immediate)1 hypersensitivity reaction to a penicillin, use:
cefazolin 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly; for patients with septic shock or requiring intensive care support, use a 6-hourly cefazolin dosing interval. For dosage adjustment in adults with kidney impairment, see cefazolin dosage adjustment. See advice on continuation therapy. cefazolin cefazolin cefazolin
For adults and children who have had a severe delayed2 hypersensitivity reaction to a penicillin, use:
vancomycin intravenously; for initial dosing, see Vancomycin dosing in adults or Intermittent vancomycin dosing for young infants and children. Loading doses are recommended for critically ill adults. See advice on continuation therapy. vancomycin vancomycin vancomycin