2025 – PAGE 304 – INFECTIOUS DISEASES
STAPHYLOCOCCUS AND STREPTOCOCCUS COMPARISON CHART
| STREPTOCOCCUS | STAPHYLOCOCCUS AUREUS |
| * GROUP A STREP (GAS = STREP pyogenes):
* PHARYNGITIS * PERITONSILLAR ABSCESSES: Use IV ampicillin-sulbactam or clindamycin, then oral amoxicillin-clavulanate or clindamycin! These all help with anaerobes! * SKIN INFECTIONS: Including cellulitis, necrotizing fasciitis, non-bullous impetigo, and erysipelas (clear raised borders). Rashes are usually erythematous and painful! * POSTSTREP GLOMERULONEPHRITIS (PSGN): Look for a low C3. PSGN is NOT preventable by early antibiotic treatment of the Strep infection! * SCARLET FEVER: Covered in the Strep section. * STREP TOXIC SHOCK SYNDROME: Can have concurrent pyogenes NECROTIZING FASCIITIS * RHEUMATIC FEVER: Covered in the Cardiology section. GROUP B STREP (GBS): * NEONATAL SEPSIS * NEONATAL PNEUMONIA STREP PNEUMONIAE: * PNEUMONIA * MENINGITIS * OTITIS MEDIA * OCCULT BACTEREMIA: * PERITONITIS * PARANASAL SINUSITIS * SEPTIC ARTHRITIS * OSTEOMYELITIS: Staph is much more common. * RARE: Cellulitis and brain abscesses STREP VIRIDANS, MUTANS, & BOVIS: * ENDOCARDITIS: VIRIDANS >> mutans or bovis |
* PURULENT SKIN INFECTIONS
* CARBUNCLES AND FURUNCLES: If < 5 cm, I&D only. No antibiotics indicated even if it’s CA-MRSA. If > 5 cm, use clindamycin or trimethoprim-sulfamethoxazole for outpatient treatment. * BULLOUS IMPETIGO: VERY thin blisters. Staph can also cause the much more common non-bullous impetigo. * NON-BULLOUS IMPETIGO: Caused more commonly by Staph than Strep. * FOLLICULITIS: Pustules with surrounding erythema. * STAPH TOXIC SHOCK SYNDROME: Associated with watery diarrhea, emesis, foreign bodies (tampon). * CHRONIC SINUSITIS: Means >90 days. Staph is more common than the H-M-S bugs (Haemophilus, Moraxella, Strep pneumoniae). * SEPTIC ARTHRITIS: Much more common than Pneumococcus * OSTEOMYELITIS: Most common etiology. * BREAST ABSCESSES: If found in a neonate, give IV antibiotics. * PEARL: If MRSA is said to be susceptible to Clindamycin but resistant to Erythromycin, give something else! * PEARL: For most skin and soft tissue infections, cephalexin, cefazolin, clindamycin, and trimethoprim-sulfamethoxazole are very acceptable therapies. If the patient has known MRSA or risk factors, clindamycin and trimethoprim-sulfamethoxazole are good first line agents. Vancomycin is IV only. Linezolid is IV or PO, but is more expensive.
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