Editing Group A streptococcal infection (section)

==Treatment==
The treatment of choice is penicillin, and the duration of treatment is around 10 days.<ref>{{cite journal |vauthors=Falagas ME, Vouloumanou EK, Matthaiou DK, Kapaskelis AM, Karageorgopoulos DE | title = Effectiveness and safety of short-course vs long-course antibiotic therapy for group a beta hemolytic streptococcal tonsillopharyngitis: a meta-analysis of randomized trials | journal = Mayo Clin Proc | volume = 83 | issue = 8 | pages = 880–9 | year = 2008 | pmid = 18674472 | doi = 10.4065/83.8.880 }}</ref> Antibiotic therapy (using injected penicillin) has been shown to reduce the risk of acute rheumatic fever.<ref>{{cite journal |vauthors=HOUSER HB, WANNAMAKER LW, RAMMELKAMP CH, DENNY FW, BRINK WR, HAHN EO, DINGLE JH | year = 1950 | title = Prophylaxis of acute rheumatic fever by treatment of the preceding streptococcal infection with various amounts of penicillin | journal = J Lab Clin Med | volume = 36 | issue = 5| page = 839 | pmid = 14784714 }}</ref> In individuals with a [[penicillin drug reaction|penicillin allergy]], [[erythromycin]], other [[macrolides]], and [[cephalosporins]] have been shown to be effective treatments.<ref name="Khan" />

Treatment with [[ampicillin/sulbactam]], [[amoxicillin/clavulanic acid]], or [[clindamycin]] is appropriate if deep oropharyngeal abscesses are present, in conjunction with aspiration or drainage.<ref>{{Cite journal |last1=Allewelt |first1=M. |last2=Schüler |first2=P. |last3=Bölcskei |first3=P. L. |last4=Mauch |first4=H. |last5=Lode |first5=H. |last6=Study Group on Aspiration Pneumonia |date=February 2004 |title=Ampicillin + sulbactam vs clindamycin +/- cephalosporin for the treatment of aspiration pneumonia and primary lung abscess |journal=Clinical Microbiology and Infection|volume=10 |issue=2 |pages=163–170 |doi=10.1111/j.1469-0691.2004.00774.x |issn=1198-743X |pmid=14759242|doi-access=free }}</ref> In cases of streptococcal toxic shock syndrome, treatment consists of penicillin and clindamycin, given with intravenous immunoglobulin.<ref>{{Cite journal |last1=Parks |first1=Tom |last2=Wilson |first2=Clare |last3=Curtis |first3=Nigel |last4=Norrby-Teglund |first4=Anna |last5=Sriskandan |first5=Shiranee |date=2018-11-01 |title=Polyspecific Intravenous Immunoglobulin in Clindamycin-treated Patients With Streptococcal Toxic Shock Syndrome: A Systematic Review and Meta-analysis |journal=Clinical Infectious Diseases|volume=67 |issue=9 |pages=1434–1436 |doi=10.1093/cid/ciy401 |issn=1058-4838 |pmc=6186853 |pmid=29788397}}</ref>

For toxic shock syndrome and necrotizing fasciitis, high-dose penicillin and clindamycin are used. Additionally, for necrotizing fasciitis, surgery is often needed to remove damaged tissue and stop the spread of the infection.<ref name=GASCDC>{{cite web|title=Group A Strep|url=https://www.cdc.gov/groupastrep/about/faqs.html|website=CDC.gov|publisher=CDC|access-date=7 December 2014}}</ref>

No instance of penicillin resistance has been reported to date, although since 1985, many reports of penicillin tolerance have been made.<ref>{{cite journal |vauthors=Kim KS, Kaplan EL | title = Association of penicillin tolerance with failure to eradicate group A streptococci from patients with pharyngitis | journal = J Pediatr | volume = 107 | issue = 5 | pages = 681–4 | year = 1985 | pmid = 3903089 | doi = 10.1016/S0022-3476(85)80392-9 }}</ref> The reason for the failure of penicillin to treat ''S.&nbsp;pyogenes'' is most commonly patient noncompliance, but in cases where patients have been compliant with their antibiotic regimen, and treatment failure still occurs, another course of antibiotic treatment with [[cephalosporins]] is common.<ref name=Khan>{{cite web|last1=Khan|first1=Zartash|title=Group A Streptococcal Infections Treatment & Management|url=http://emedicine.medscape.com/article/228936-treatment#a1156|website=Medscape|access-date=7 December 2014}}</ref>

The 30-valent N-terminal M-protein-based vaccine as well as the M-protein vaccine (minimal epitope J8 vaccine) are two vaccines for GAS that are currently getting close or becoming clinical studies, however, other vaccines using conserved epitopes  are progressing.<ref name=":22">{{Cite journal|last1=Nelson|first1=George E.|last2=Pondo|first2=Tracy|last3=Toews|first3=Karrie-Ann|last4=Farley|first4=Monica M.|last5=Lindegren|first5=Mary Lou|last6=Lynfield|first6=Ruth|last7=Aragon|first7=Deborah|last8=Zansky|first8=Shelley M.|last9=Watt|first9=James P.|last10=Cieslak|first10=Paul R.|last11=Angeles|first11=Kathy|date=2016-08-15|title=Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005–2012|journal=Clinical Infectious Diseases|language=en|volume=63|issue=4|pages=478–486|doi=10.1093/cid/ciw248|pmid=27105747|pmc=5776658|issn=1058-4838}}</ref>