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Management of Group A Streptococcal Cultures of the Throat, Rectum, or Vagina - Adult/Pediatric - Ambulatory [63]

Management of Group A Streptococcal Cultures of the Throat, Rectum, or Vagina - Adult/Pediatric - Ambulatory [63] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols




Delegation Protocol Number: 63

Delegation Protocol Title:
Management of Group A Streptococcal Cultures of the Throat, Rectum, or Vagina - Adult/Pediatric - Ambulatory

Delegation Protocol Applies To:
UW Health Primary Care Clinics and Health Line

Target Patient Population:
Adult and Pediatric patients (greater than 3 months of age)

Delegation Protocol Champion:
Ellen Wald, MD – Department of Pediatrics, Infectious Disease
Richard Ellis, MD – Department of Pediatrics
Gail Allen, MD – Department of Pediatrics
Matthew Swedlund, MD – Department of Family Medicine
Michelle Bryan, MD – Department of Family Medicine

Delegation Protocol Reviewers:
Laura Brunner, RN – American Family Children’s Hospital, Pediatric Specialties Clinics
Cheryl DeVault, BSN, RN, OCN – Clinic Operations Manager, Yahara Clinic
Denise Schmitt, RN – Clinical Supervisor, Pediatrics, West Towne

Responsible Department:
Department of Pediatrics
Department of Family Medicine

Purpose Statement:
To delegate authority from the patient’s provider to Registered Nurses (RNs) to order medications for treatment of
Group A Strep (GAS) infections of the throat, rectum, or vagina in patients with cultures positive for streptococcus.

Who May Carry Out This Delegation Protocol:
RNs trained in the use of this delegation protocol.

Guidelines for Implementation:
1. The protocol is initiated when culture results are returned for streptococcal infections of the throat, rectum,
or vagina in a patient 3 months of age or older. If a rectal or vaginal culture is positive in a pediatric patient,
the RN should consult provider regarding potential mandatory reporting.
2. Contraindications to this protocol. No antibiotics will be ordered and RN will contact a provider for next steps:
2.1. Pregnancy
2.2. Throat cultures positive for Non Group A streptococcal only
2.3. Completion of a course of antibiotics within 2 weeks of obtaining the culture
2.4. Allergies to all treatment options (penicillins, cephalosporins and macrolides).
2.5. Inability to take medicines by mouth or vomiting
2.6. Asymptomatic patients being tested for carriage
3. Upon receipt of the final culture results the RN will inform patient (or family, if patient is a minor) of results
and document method of notification in the patient’s medical record.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


3.1. If the final culture result is negative, patients will be informed either by phone, letter, or MyChart. If the
patient has begun treatment the staff will call with the results and advise to discontinue treatment,
unless otherwise indicated in the provider plan of care.
3.2. If the culture is positive, the RN will order antibiotics as outlined in Table 1. Prior to placing orders the RN
will review the patient’s medical record including allergies, medications, current weight and provider
notes regarding the visit.
4. Management of patients with throat, rectal or vaginal cultures positive for Group A Strep (GAS).
The RN will place orders for first line therapy as outlined in Table 1 unless the patient is allergic to or intolerant
of penicillins. In that case the RN will move to subsequent antibiotics. If the patient has is allergic to or has had
a treatment failure to all of the listed antibiotics the RN will consult a provider before placing any orders.

Table 1. Group A Strep Antibiotics and Doses
Weight Medication
First Line Therapy
Less than 27 kg (<60 lbs) Penicillin VK 250 mg PO twice daily for 10 days
27 kg or greater (>= 60 lbs) Penicillin VK 500 mg PO twice daily for 10 days
Patients unable to swallow tablets
Less than 20 kg (<44 lbs) Amoxicillin 50 mg/kg (max 1000 mg/dose) PO once daily for 10 days

If unable to tolerate once daily dosing, substitute amoxicillin 25 mg/kg/dose
(max 500 mg/dose) PO twice daily for 10 days
20 kg or greater (>=44 lbs) Amoxicillin 1000 mg PO once daily for 10 days

If unable to tolerate once daily dosing, substitute amoxicillin 500 mg PO twice
daily for 10 days
Patients unable to tolerate penicillin and who have no history of allergy with hives or anaphylaxis to
cephalosporins
Less than 20 kg (<44 lbs) Cephalexin 25 mg/kg/dose (max 500 mg/dose) PO twice daily for 10 days
20 kg or greater (>=44 lbs) Cephalexin 500 mg PO twice daily for 10 days
Patients with immediate/severe reaction to penicillin or known cephalosporin allergy
Less than 40 kg (<88 pounds) Azithromycin 12 mg/kg/day PO (max 500 mg/dose) once daily for 5 days
40 kg or greater (>=88 lbs) Azithromycin 500 mg PO as a single dose followed by 250 mg PO once daily
for 4 days
PO = By mouth

5. Management of patients with positive Group C or G streptococcal throat cultures:
5.1. The RN will contact the patient/parent upon receipt of the final culture results to inquire about continued
symptoms.
5.2. If a sore throat is still present and/or a fever persists, treat using the antibiotics listed in Table 1 for 5 days
only.
5.3. If the patient is feeling better and reports no sore throat or fever, do not treat.
Order Mode:
Protocol/Policy, Without Cosign

References:
1. American Academy of Pediatrics (AAP). Red Book: 2015 Report of the Committee on Infectious Diseases. Elk
Grove Village, IL
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


2. Gerber MA, Baltimore RS, Eaton CB, et al, “Prevention of Rheumatic Fever and Diagnosis and Treatment of
Acute Streptococcal Pharyngitis: A Scientific Statement From the American Heart Association Rheumatic
Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young,
the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary
Council on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics,
Circulation, 2009, 119(11):1541-51. [PubMed 19246689]
3. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group
A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012;
55:1-14.

Collateral Documents/Tools: NA

Approved By:
UW Health Ambulatory Protocol Committee: November 2011; August 2015
Antimicrobial Use Subcommittee: November 2011; November 2015
UW Health Pharmacy and Therapeutics Committee: December 2011; February 2015
UWHC Medical Board: January 2014; March 2016
UW Health Chief Medical Officer: March 2016

Effective Date: March 2016

Scheduled for Review: April 2019

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org