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In severe invasive infection with Group A streptococci, household contacts (partner and children) should be treated prophylactically within seven days after contact with the index patient.

There are three options:

• azithromycin: adults: 500 mg once daily for 3 days, children ≥ 1 month: 20 mg/kg once daily (max. 500 mg) for 3 days.  Azithromycin is first choice, unless macrolide resistance is present (based on the antibiogram).

• pheneticillin (Broxil): (adults: 500 mg four times daily, children ≥ 1 month: 40 mg/kg/24 hours divided into three doses) for 10 days with rifampicin (adults: 600 mg twice daily, children ≥ 1 month: 10 mg/kg twice daily) during the first four days.

• clindamycin: (adults: 600 mg three times daily, children: 25 mg/kg/24 hours divided into four doses) for 10 days.

Pregnant women:

There are three options:

• azithromycin: 500 mg once daily for 3 days.  Azithromycin is first choice, unless macrolide resistance is present (based on the antibiogram).

• pheneticillin (Broxil): 500 mg four times daily for 10 days.

• clindamycin: 600 mg three times daily for 10 days.