Home > Treatment Recommendations > Culture-Directed Infections > Endocarditis > Viridans Group Streptococci, Streptococcus gallolyticus (S. bovis biotype I)

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	2 weeks	2 weeks
or
[Ceftriaxone	2g IV daily	2 weeks	6 weeks
+
Gentamicin]	3mg/kg IV q24h	2 weeks	2 weeks
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	2 weeks	6 weeks
or
[Ceftriaxone	2g IV daily	NA	6 weeks
+
Gentamicin]	3mg/kg IV q24h	NA	6 weeks
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	4 weeks	6 weeks
Severe penicillin/ cephalosporin allergy
Vancomycin	15mg/kg IV q8-12h	4 weeks	6 weeks