Antibiotic chemoprophylaxis for close contacts of invasive group A streptococcus in community settings: Evidence review

Objectives: Revised UK guidelines for the management of contacts of invasive group A Streptococcus (iGAS) infection in community settings were published in December 2022. We present the findings of a narrative review which informed the public health recommendations around the provision of antibiotic chemoprophylaxis detailed in the updated guidelines. Methods: We conducted a literature review of studies reporting the risk of iGAS infection associated with specific risk factors. Results: There was strong epidemiological evidence for an increased risk of iGAS infection in contacts who are older individuals, post-partum women, neonates and individuals with chickenpox infection; evidence on the impact of influenza co-infection, injecting drug use or being homeless in increasing risk of iGAS infection was less robust. Conclusions: The guidelines made recommendations to offer chemoprophylaxis to close contacts of iGAS cases who are aged ≥75 years, pregnant ≥37 weeks gestation, post-partum, neonates or those with a recent history of, or current chickenpox infection. Systematic data collection evaluating the use of chemoprophylaxis and other control measures is recommended.