Viridans Group Streptococci, Streptococcus gallolyticus (S. bovis biotype I)

Penicillin MIC ≤ 0.12 µg/mL

Therapy Dose Duration
    Native Prosthetic
Penicillin 3MU IV q4h 4 weeks NA
or      
Ceftriaxone 2g IV daily 4 weeks NA
or      
[Penicillin 3MU IV q4h 2 weeks 6 weeks
+      
Gentamicin] 3mg/kg IV q24h or 2 weeks 2 weeks
  1mg/kg IV q8h    
or      
[Ceftriaxone 2g IV daily 2 weeks 6 weeks
+      
Gentamicin] 3mg/kg IV q24h or 2 weeks 2 weeks
  1mg/kg IV q8h    
Severe penicillin/ cephalosporin allergy      
Vancomycin 15 mg/kg IV q8 - 12h 4 weeks 6 weeks

Penicillin MIC > 0.12 - < 0.5 µg/mL

- For penicillin MIC > 0.1µg/mL, ensure MIC to ceftriaxone ≤ 1µg⁄mL.

 

Therapy Dose Duration
    Native Prosthetic
Ceftriaxone 2g IV daily 4 weeks NA
or      
[Penicillin 4MU IV q4h 4 weeks 6 weeks
+      
Gentamicin] 3mg/kg IV q24h or 2 weeks 6 weeks
  1mg/kg IV q8h    
or      
[Ceftriaxone 2g IV daily NA 6 weeks
+      
Gentamicin] 3mg/kg IV q24h or NA 6 weeks
  1mg/kg IV q8h    
Severe penicillin/ cephalosporin allergy      
Vancomycin 15mg/kg IV q8-12h 4 weeks 6 weeks

Penicillin MIC ≥ 0.5µg/mL

- If ceftriaxone MIC ≥ 2µg/mL or penicillin MIC ≥ 4µg/mL, use vancomycin (4 weeks for native valve, 6 weeks for prosthetic valve) + gentamicin (2 weeks for native valve, 6 weeks for prosthetic valve). Consult Infectious Diseases.

 

Therapy Dose Duration
    Native Prosthetic
[Ceftriaxone 2g IV daily 4 weeks 6 weeks
+      
Gentamicin] 3mg/kg IV q24h or 4 weeks 6 weeks
  1mg/kg IV q8h    
Severe penicillin/ cephalosporin allergy      
Vancomycin 15mg/kg IV q8-12h 4 weeks 6 weeks