Treatment of Infective Endocarditis Due to Oral Streptococci or Streptococcus gallolyticus Group

Clinical Scenario

This protocol applies to infective endocarditis caused by oral streptococci or the Streptococcus gallolyticus group — including cases that are susceptible with increased exposure, or resistant, to penicillin. It covers both native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE).

Treatment Approach (partial)

Guideline-recommended therapy involves a beta-lactam antibiotic combined with an aminoglycoside. The specific agents, duration, and regimen differ between NVE and PVE — the complete protocol with full dosing guidance is available via the link below.

Treatment Goals

Clinical stability sufficient for transition to outpatient antibiotic therapy (OPAT) is assessed at 10–14 days. Success criteria include absence of fever for more than 2 days, CRP below 20 mg/L (or below 25% of the peak measured value), and leukocyte count below 15 × 10⁹/L.

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References

DOI: 10.1093/eurheartj/ehad193

In patients with NVE due to oral streptococci and S. gallolyticus, penicillin G, amoxicillin, or ceftriaxone for 4 weeks in combination with gentamicin for 2 weeks is recommended using the following doses:

In patients with PVE due to oral streptococci and S. gallolyticus, penicillin G, amoxicillin, or ceftriaxone for 6 weeks combined with gentamicin for 2 weeks is recommended using the following doses:

After 10–14 days of therapy, OPAT or outpatient oral antibiotic therapy should be considered if clinically stable (see Section 7.13).

Satisfying response to treatment: no fever >2 days, CRP <25% of max measured value or <20 mg/L and leukocytes <15 × 10⁹/L

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