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Effectiveness of Clindamycin and Intravenous Immunoglobulin, and Risk of Disease in Contacts, in Invasive Group A Streptococcal Infections

Carapetis, Jonathan R., Jacoby, Peter, Carville, Kylie, Ang, Joel Seong-Jin, Curtis, Nigel and Andrews, Ross M. (2014). Effectiveness of Clindamycin and Intravenous Immunoglobulin, and Risk of Disease in Contacts, in Invasive Group A Streptococcal Infections. Clinical Infectious Diseases,59(3):358-365.

Document type: Journal Article
Citation counts: Altmetric Score Altmetric Score is 36
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IRMA ID 11436xPUB53
Title Effectiveness of Clindamycin and Intravenous Immunoglobulin, and Risk of Disease in Contacts, in Invasive Group A Streptococcal Infections
Author Carapetis, Jonathan R.
Jacoby, Peter
Carville, Kylie
Ang, Joel Seong-Jin
Curtis, Nigel
Andrews, Ross M.
Journal Name Clinical Infectious Diseases
Publication Date 2014
Volume Number 59
Issue Number 3
ISSN 1058-4838   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84904972009
Start Page 358
End Page 365
Total Pages 8
Place of Publication United States
Publisher Oxford University Press
HERDC Category C1 - Journal Article (DIISR)
Abstract Background. The use of clindamycin and intravenous immunoglobulin (IVIG) in treatment of invasive group A streptococcal (iGAS) infection, and the need for prophylactic antibiotics in close contacts, remains contentious. Controlled trials are unlikely to be conducted, so prospective, observational studies provide the best data to inform practice.

Methods. We conducted population-based, prospective, active surveillance of iGAS infections throughout the state of Victoria, Australia (population 4.9 million), from March 2002 through August 2004.

Results. Eighty-four cases of severe iGAS infection (streptococcal toxic shock syndrome, necrotizing fasciitis, septic shock, or GAS cellulitis with shock) were identified. Clindamycin-treated patients had more severe disease than clindamycin-untreated patients but lower mortality (15% vs 39%; odds ratio [OR], 0.28; 95% confidence interval [CI], .10–.80). Among those who received concurrent IVIG, the fatality rate was lower still (7%). The adjusted point estimate of the OR for mortality was lower in clindamycin-treated patients (0.31; 95% CI, .09–1.12) and clindamycin plus IVIG–treated patients (0.12; 95% CI, .01–1.29) compared with clindamycin-untreated patients. Three confirmed cases of iGAS infection occurred in household contacts of index cases. The incidence rate of iGAS disease in contacts was 2011 (95% CI, 413–5929) times higher than the population incidence in Victoria.

Conclusions. Our data suggest that clindamycin treatment of patients with severe iGAS infections substantially reduces mortality and that this effect may be enhanced by concurrent treatment with IVIG. The dramatically increased risk of iGAS disease among household contacts within 1 month of the index case highlights a potential role for antibiotic prophylaxis.
Keywords streptococcal
clindamycin
immunoglobulin
contact
mortality
DOI http://dx.doi.org/10.1093/cid/ciu304   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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