As the streptococci continue to colonize, the formation of a biofilm may arise and its protective properties may make it more difficult to treat the infection with antibiotics.In cases of perianal cellulitis infections that are not treated properly, group A beta-hemolytic streptococci may cross into the bloodstream through the epithelium of the perianal area to cause serious infections such as necrotizing fasciitis or toxic shock syndrome. The group A beta-hemolytic streptococci bacteria that enter the bloodstream are able to cause serious infections by overpowering natural immune responses and allowing bacteria to rapidly multiply to cause harm to the body. Treatment
After the diagnosis of perianal streptococcal dermatitis has been confirmed, the most successful treatment regimens utilize a combination of topical and systemic antibiotics. Oral antibiotics are the recommended first-line treatment for perianal streptococcal dermatitis. Perianal streptococcal dermatitis does not resolve on its own. The treatment of choice for oral antibiotics include "penicillin V, azithromycin, clarithromycin, clindamycin, erythromycin, penicillinase-resistant penicillin, or cephalosporins." Oral antibiotics work best in combination with a topical antibiotic such as mupirocin, or an antiseptic such as chlorhexidine. Due to the affect that perianal streptococcal dermatitis has on the deeper layers of the skin, topical antimicrobial therapy alone appears to be poorly effective. Treatment duration ranges from 14 to 21 days and treatment success is determined by clinical examination and post-treatment swabbing of the affected area to confirm that the infection is no longer present. Prevention & Recurrence
There is little data that currently exists on the prevention of perianal cellulitis.
Phenylephrine/ketorolac, sold under the brand name Omidria, is a combination drug used during cataract surgery or intraocular lens replacement to prevent intraoperative miosis and to reduce postoperative pain. It contains phenylephrine and ketorolac.Phenylephrine/ketorolac was approved for medical use in the United States in May 2014, and in the European Union in July 2015. References
External links
"Ketorolac mixture with phenylephrine". Drug Information Portal. U.S. National Library of Medicine.