$5 million boost for world-first trial tackling strep infections in both children and adults

A major new clinical trial, the Streptococcal Adaptive Platform (STRAP), has received $5 million in funding from the Australian Government’s Medical Research Future Fund (MRFF) to improve treatment for life-threatening streptococcal infections across all age groups.

Spearheaded by leading researchers and clinicians from the Doherty Institute, Murdoch Children's Research Institute (MCRI), and other national and international partners, STRAP will explore the most effective treatments for severe forms caused by two types of Strep bacteria: Strep A and Strep C/G.

Serious infections caused by Strep A, also known as Group A Streptococcus, can sometimes result in invasive infections referred to as invasive Group A Streptococcal disease (iGAS). Severe cases of Strep A and Strep C/G occur when these bacteria enter sterile areas of the body, leading to sepsis, necrotising fasciitis and toxic shock syndrome.

In 2023, Australia recorded nearly 3,000 cases of invasive Strep A, more than double the number in previous years. In children, particularly those under five or with underlying conditions, invasive Strep A can progress rapidly and lead to severe complications.

First Nations people are disproportionately affected by invasive Strep A and Strep C/G, with rates up to ten times higher than those of non-Indigenous Australians.

With both infection rates and treatment uncertainty on the rise, researchers say the STRAP trial is urgently needed.

The Royal Melbourne Hospital’s Associate Professor Katherine Gibney, an infectious diseases physician based at the Doherty Institute and Chief Investigator, welcomed the funding, stating that STRAP will test several combinations of treatments to identify those that genuinely help patients recover and those that may be ineffective or even harmful.

“While penicillin remains the mainstay of treatment for invasive infections with Strep A or Strep C/G, many doctors also prescribe additional medications like ceftriaxone, clindamycin, linezolid, or an expensive blood product known as intravenous immunoglobulin. But there’s currently little solid evidence to show which combinations of these treatments work best,” said Dr Gibney.

“This trial aims to change that. For the first time, we’ll have clear, high-quality evidence to guide the treatment of these deadly infections. This will help clinicians make informed decisions, save lives and avoid unnecessary or harmful interventions,” she added.

Dr Josh Osowicki, a Paediatric Infectious Diseases Physician at MCRI and co-Chief Investigator, said clinicians are currently relying on what they believe to be best practices without clear data.

“In recent years, paediatric hospitals around the world have been treating an unusually high number of children with life-threatening streptococcal infections,” said Dr Osowicki.

“The STRAP study will provide the answers clinicians need to better treat children with streptococcal infections and improve their quality of life.”

Beyond its impact on individuals, the disease places a significant strain on health systems, with intensive care and long hospital stays often required.  In Australia, the annual disease-related cost burden of hospitalised iGAS is estimated to be over $140 million.

The $5 million grant will support the trial’s next crucial phase, including finalising the study design, securing ethics approvals and starting patient recruitment in Australian hospitals by late 2025. Over the next four years, STRAP aims to enrol more than 2,000 participants across Australia, Canada, New Zealand and the UK.

STRAP builds on the foundation of the successful Staphylococcus aureus bacteraemia Network Adaptive Platform Trial (SNAP) trial, which brought together over 100 hospitals across eight countries.

Crucially, STRAP has been co-designed with patients and communities. A dedicated Consumer Reference Group has already helped shape the trial to ensure it reflects the priorities and lived experiences of patients and their families.