Viridans-Group Streptococci

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Background

Types

  • Streptococcus milleri
  • Streptococcus sanguis
  • Streptococcus mitis
  • Streptococcus bovis

Risk Factors for Viridans Bacteremia[2]

  • neutropenia
  • oral mucositis
  • irradiation to the oral cavity
  • antibiotic prophylaxis with trimethoprim-sulfamethoxazole or fluoroquinolones
  • intravenous hyperalimentation
  • high dose chemotherapy

Antibiotic Sensitivities[3]

Category Antibiotic Viridans strep
Penicillins Penicillin G I
Penicillin V I
Methicillin I
Nafcillin/Oxacillin I
Cloxacillin/Diclox. I
Amino-Penicillins AMP/Amox I
Amox-Clav I
AMP-Sulb I
Anti-Pseudomonal Penicillins Ticarcillin I
Ticar-Clav I
Pip-Tazo I
Piperacillin I
Carbapenems Doripenem S
Ertapenem S
Imipenem S
Meropenem S
Aztreonam R
Fluroquinolones Ciprofloxacin R
Ofloxacin R
Pefloxacin X1
Levofloxacin S
Moxifloxacin S
Gemifloxacin S
Gatifloxacin S
1st G Cephalo Cefazolin S
2nd G. Cephalo Cefotetan S
Cefoxitin S
Cefuroxime S
3rd/4th G. Cephalo Cefotaxime S
Cefizoxime S
CefTRIAXone S
Ceftaroline S
CefTAZidime I
Cefepime S
Oral 1st G. Cephalo Cefadroxil S
Cephalexin S
Oral 2nd G. Cephalo Cefaclor/Loracarbef S
Cefproxil R
Cefuroxime axetil S
Oral 3rd G. Cephalo Cefixime S
Ceftibuten R
Cefpodox/Cefdinir/Cefditoren S
Aminoglycosides Gentamicin X1
Tobramycin X1
Amikacin X1
Chloramphenicol X1
Clindamycin X1
Macrolides Erythromycin X1
Azithromycin X1
Clarithromycin X1
Ketolide Telithromycin X1
Tetracyclines Doxycycline X1
Minocycline X1
Glycylcycline Tigecycline X1
Daptomycin X1
Glyco/Lipoclycopeptides Vancomycin X1
Teicoplanin X1
Telavancin X1
Fusidic Acid X1
Trimethoprim X1
TMP-SMX X1
Urinary Agents Nitrofurantoin X1
Fosfomycin X1
Other Rifampin X1
Metronidazole X1
Quinupristin dalfoppristin X1
Linezolid X1
Colistimethate X1

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

Table Overview

See Also

References

  1. Antibiotic Therapy for Positive Blood Cultures. Perez-Jorge EV, et al. Antimicrobe. http://www.antimicrobe.org/new/e38rev2.asp
  2. Antibiotic Therapy for Positive Blood Cultures. Perez-Jorge EV, et al. Antimicrobe. http://www.antimicrobe.org/new/e38rev2.asp
  3. Sanford Guide to Antimicrobial Therapy 2014