Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection

Pediatr Infect Dis J. 1999 Dec;18(12):1096-100. doi: 10.1097/00006454-199912000-00014.


Context: Animal model studies have demonstrated the failure of penicillin to cure Streptococcus pyogenes myositis and have suggested that clindamycin is a more effective treatment.

Objective: To determine the most effective antibiotic treatment for invasive S. pyogenes infection in humans.

Design and setting: We conducted a retrospective review of the outcomes of all inpatients from 1983 to 1997 treated for invasive S. pyogenes infection at Children's Hospital.

Patients: Fifty-six children were included, 37 with initially superficial disease and 19 with deep or multiple tissue infections.

Main outcome measure: Lack of progression of disease (or improvement) after at least 24 h of treatment.

Results: The median number of antibiotic exposures was 3 per patient (range 1 to 6) with clindamycin predominating in 39 of 45 courses of protein synthesis-inhibiting antibiotics and beta-lactams predominating amongst the cell wall-inhibiting antibiotics in 123 of 126 of the remainder. Clindamycin was often used in combination with a beta-lactam antibiotic. Overall there was a 68% failure rate of cell wall-inhibiting antibiotics when used alone. Patients with deep infection were more likely to have a favorable outcome if initial treatment included a protein synthesis-inhibiting antibiotic as compared with exclusive treatment with cell wall-inhibiting antibiotics (83% vs. 14%, P = 0.006) with a similar trend in those with superficial disease (83% vs. 48%, P = 0.07). For those children initially treated with cell wall-inhibiting antibiotics alone, surgical drainage or debridement increased the probability of favorable outcome in patients with superficial disease (100% vs. 41%, P = 0.04) with a similar trend in a smaller number of deep infections (100% vs. 0%, P = 0.14).

Conclusions: This retrospective study suggests that clindamycin in combination with a beta-lactam antibiotic (with surgery if indicated) might be the most effective treatment for invasive S. pyogenes infection.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Clindamycin / therapeutic use*
  • Fasciitis, Necrotizing / drug therapy*
  • Humans
  • Infant
  • Infant, Newborn
  • Retrospective Studies
  • Streptococcal Infections / drug therapy*
  • Streptococcus pyogenes*
  • beta-Lactams


  • Anti-Bacterial Agents
  • beta-Lactams
  • Clindamycin