Group A Strep Necrotizing Fasciitis

presents with necrotizing fasciitis. cultures grow Streptococcus pyogenes (Group A Streptococcus). The team orders penicillin + clindamycin. Your student asks why clindamycin is added since penicillin covers GAS.

You tell them…

Anti-toxin effect
C. difficile risk
Penicillin resistance
No reason

How did others respond?

Reveal the answer

Best Answer

Anti-toxin effect

Explanation: IDSA guidelines recommend penicillin + clindamycin in necrotizing GAS infections. Though GAS is always susceptible to penicillin, clindamycin is added to ⬇️ tissue damage.

Linezolid also inhibits toxin production and is a proposed alternative to clindamycin, given clindamycin resistance has ⬆️ in the 🇺🇸. A small study in severe GAS skin infections showed similar mortality between linezolid & clindamycin groups.

Tap down toxin production in GAS with 2 drugs! 💉💉