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caused by streptococcus pyogenes as an alternative to first line therapy in individuals who cannot use first line therapy note penicillin by the intramuscular route is the usual drug of choice in the treatment of streptococcus pyogenes infection and the prophylaxis of rheumatic fever azithromycin for oral suspension usp is often effective in the eradication of susceptible strains of streptococcus pyogenes from the nasopharynx because some strains are resistant to azithromycin for oral suspension usp susceptibility tests should be performed when patients are treated with azithromycin for oral suspension usp data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available uncomplicated skin and skin structure infections due to staphylococcus aureus streptococcus pyogenes or streptococcus agalactiae abscesses usually require surgical drainage urethritis and cervicitis due to chlamydia trachomatis or neisseria gonorrhoeae genital ulcer disease in men 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