Strep A skin infection - anyone got any experience?

[Feierabend]

DD2 (5 months) was diagnosed with a Strep A skin infection about 10 days ago after being misdiagnosed with eczema. She had 5 days of Amoxicillin plus anti fungal cream for her skin folds, which were bright pink and weeping, for good measure. It all cleared up beautifully until the day she came off her ABx, when suddenly she got a rash behind her knees, followed by a few red spots on her legs and tummy. Alarm bells rung and I took her to the GP who gave her another 5 day's worth of Amoxicillin AND the anti fungal cream, but said to him it looked like eczema after all. She's been back on ABx for a day now but I haven't seen an improvement yet. So, my question - has anyone else's child had this type of skin infection? What was the treatment and how long did it take till it cleared up? Any ideas on what else I could do apart from feeding her her medicine? Do her clothes / bedding need to be washed daily, and how hot? Any other tips greatly appreciated, thanks!

[Feierabend]

bump

[alypaly]

hi again Feierabend. The doc should be giving you flucloxacillin not amoxycillin for strep A skin infections and a cream called fucidin not an antifungal one. I thought he had given you fluclox before, when we last spoke.if it didnt clear up the first time with amoxycillin, its highly unlikely to clear up with a second dose of the same. Amoxycillin is not for deep seated skin infections anyway.

[Feierabend]

Hi Aly, thanks for coming to help. Yes we started off with 2 days of Fluclox, then the paed phoned me with the results of the swabs and said since it's strep not staph, we should switch to Amoxicillin. Which we did on Friday. The cream is called Clotrimazole 1%. It did pretty much disappear then seemed to reappear the day she had the last dose of the ABx. I am thinking about going back to the hospital because I have no confidence in my GP.

[Feierabend]

I also thought that given how bad it was, a 5 day course sounded quite short - the paed at the hospital did say she might well need 2 weeks of ABx. What do you think?

[alypaly]

#the other antibiotics for strep A are cephalexin (Keflex, ,

cefadroxil

# cefaclor if amox isnt working he could try these and fucidin cream. i am not surprised you have lost your confidence

[Feierabend]

Is Clotrimazole similar to Fucidin?

[Guimauve]

Gah! I thought the paed continued the fluclox! Might at least have gone for co-amoxiclav! Clotrimazole anti-fungal, fucidin antibacterial, specifically ant-staph.

Were the original swabs taken before any abx were started? Swab results from samples taken whilst on abx are not reliable.

[alypaly]

Guimauve is correct, the antibiotic that she was on would have negated/or clouded the lab results for the swab to a great degree.
Yes i too you would have thought doc would have hit it with co-amox to cover all options. Clotrimazole is an antifungal ( bettter known as canestan)as G says is for thrush (candida) and can be used anywhere on the body for things like athletes foot etc,but when a rash spreads as quickly and you then catch it(as you said) so quickly,it is highly unlikely to be fungal...more likely bacterial like an impetigo type infection, which is why i thought he may have given you fucidin,

Gah !!!!doctors

are you medical too Guimauve ?

[Guimauve]

Pharmacist Aly, you too?

How're things this morning Feier?

[Feierabend]

Yes swabs were taken in hospital before we started ABx. Paed there said the lab had recommended switching to Amoxicillin, she was going to phone me back again the next day once they had tested how the bacteria would react to Amoxicillin but she never did, since she knew I had switched I assumed the lab stuck with the recommendation. As I said, rash disappeared pretty quickly after that but the infected skin folds took a bit longer and on the last day of ABx were still slightly pink and looking like they were still healing. I don't know if coming off the ABx meant that they had a chance to spread again. The reason paed went for antifungal cream is that she wanted to cover all eventualities, as she said it was obviously bacterial but that there might be an overlying fungal infection in the skin folds as well. GP I saw on Thursday to extend course of ABx gave me some antiseptic moisturiser as well. He said her skin looked dry (it does in places) and when I said I was worried about moisturising her in case that would spread any remaining infection he gave me that stuff.

When DD2 was given Fluclox, she was put on a high dose (5 mls). When we switched to Amoxicillin, GP prescribed the paed version with 1.25 mls - could/should he have gone for more?

So, this morning. Things looking better again. Skin folds still healing, but little red spots that I saw on her tummy and legs last night have gone. It's now pretty obvious that she has dry patches on her ankles, calves and behind her knees. I've rubbed some of that moisturiser in and will repeat later on. I don't think the infection IS coming back after all, or it would look worse by now. Will keep a very close eye on her though and if I see any more rashes at all I'll be straight back at the doctor's.

So you both think Amoxicillin was wrong?

[Feierabend]

What I am worried about is that on top of the strep there might be staph as well - but they would have seen that in the lab, no? Or might they have sneaked in since? As her skin has been weakened by 4 weeks of being infected?

[alypaly]

Feierabend 5mls is just the amount you give her ,it is not the strength, The strenght is in milligrams on the bottle...fluclox is either 125 or 250mg.

Amoxycillin is 125mg or 250 but there is a paediatric version with a dropper bottle that you give 1.25mls(which is on the dropper) but the strength is still 125mg.

i am sure if there were staphs and streps they would show on lab cultures but again like Guimauve said its difficult to assess because she had already been put on antibiotics.

What the doc should have done is to have swabbed the skin prior to the abx and then sent the swabs off and given you whats calleda broad spectrum antibiotic. Saying that ,most childrens skin infections respond to fluclox in my experience

[Guimauve]

Amoxicillin not wrong, no. Perfectly sensible choice for strep, especially if microbiology lab showed that the bug they grew was sensitive. Some staph would also respond to amox, though many are resistant. That is where the other ab we mentioned, co-amoxiclav, comes in. It has activity against a wide range of bugs. However, it is more prudent to use a narrow-spectrum, targeted ab if you know what the bug is. In an ideal world all infections would be treated with the really broad antibiotics, but this is exactly what causes antibiotic resistance to develop.

It is possible that there could be a secondary infection, esp in view of the previous steroid use. Also possible that the infection you had was unrelated to H's, but could have cross-contaminated. And also possible that it was the beginnings of eczema, but very unluckily got infected. It does sound like the infection is resolving - how is she in herself. Does she seem 'better'? No temp etc?

[Guimauve]

And re: the dose, 125mg is the double dose for a baby H's age, the standard dose would be half that, so he had gone as high as he could. Nice to not have to get the larger volume down her, eh?

[alypaly]

Guimauve are you a manager pharmacist,owner or locum?....I am a dispenser...but have recently chosen to leave my position. I have been a dispenser and medical rep for the past 33 years and am really missing not working in the pharmacy environment. I left a well paid job because of the conditions i was put under and i would really like to work for someone who appreciates my dedication to the job. Which area do you work in ,if you dont mind me asking. You dont know any one in the greater manchester area who requires a qualified dispenser do you? I have specialised in dermatolgy,gastroenterology,diabetes,anti-arthritics,contraception,passed smoking cessation programme,OTC medicines and have been left to run pharmacy in every aspect during locum visits. I am experienced at buying, stock control and price negotiation.

[Guimauve]

Sorry Aly, I'm a hospital pharmacist in the South East! But I would strongly recommend contacting some of the hospitals in Manchester - you sound ideally suited for a clinical tech role, although I imagine you might have to do some medicines management courses once in post. Roles for techs are expanding rapidly in the hospital sector, lots of opportunities, foundation degree in meds management etc. I imagine you visited hospitals working as a rep? I would like to think you don't get put under the same pressures in hospital as you do in retail, as you don't have the same onus on targets/ profit, but that is probably a gross generalisation!

[Guimauve]

Sorry for hijack Fei!

[alypaly]

yes sorry fei!
thanks Guimauve.

My son is a uni in his fourth year doing pharmacy....just got accepted at the QMC for pre reg so he is delighted.Must be in our blood.

[alypaly]

i think im a frustrated doc at heart but parents never gave me the chance to go to uni?

[CarGirl]

Hi

We had an absolutely nightmare with strep A - misdiagnosed as thrush for 18 months!!!!! (just don't ask about how fuming I was considering she had EVERY symptom of it being strep A including a bleeding ANus)

We had to give 3 weeks worth of antiobotics to get rid of it, please be aware that strep A can be very serious if it gets into the blood stream ie through an open wound, chicken pox blisters etc.

[alypaly]

that was a long time to have it misdiagnosed
CarGirl....didnt he think to do anything about it properly in 18months...did he not refer u to a specialist

[kazkiss]

Hi Aly! (sorry for hijacking thread fei)

Aly you should definately look into becoming a clinical tech!

DO you have any pharmacy related qualifacations such as city and guilds, apocathery hall or NVQ / btec. If not you could do a 2 year work placement college course to become a tech.

Message me or Ju for any more info!

[Guimauve]

Kaz, stop touting for new staff! Aly is in Manchester!

[kazkiss]

bugger !

[kazkiss]

lol soo always good to be friendly haha . in case of southernly relocation.