Clindamycin and Intravenous Immunoglobulin for Invasive Group A Streptococcal Infection: Is the Jury Still Out?

In the management of invasive group A streptococcal (iGAS) infection, outstanding issues are whether adding clindamycin improves outcomes over β-lactam antibiotic alone, whether intravenous immunoglobulin (IVIG) further improves outcomes, and whether antibiotic prophylaxis for close contacts might be beneficial. Because iGAS is rare, a controlled trial examining these issues is unlikely to be achieved. Instead, investigators performed an active, prospective, enhanced-surveillance study in the state of Victoria, Australia, between March 1, 2002, and August 31, 2004, and found 333 patients whose condition met a case definition of iGAS, of whom 84 had severe disease. The authors also retrospectively collected data on household contacts for iGA…