Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

Streptococcal, Non-Group A Infections

For further information, see CMDT Part 33-01: Streptococcal Infections

Key Features

  • Non-group A hemolytic streptococci (eg, groups B, C, and G) produce a spectrum of disease similar to that of group A streptococci

  • Viridans streptococci are part of the normal oral flora but may produce focal pyogenic infection

Clinical Findings

  • Group B streptococci

    • An important cause of sepsis, bacteremia, and meningitis in the neonate

    • Antepartum screening to identify carrier mothers is recommended

    • May cause septic abortion, endometritis, or peripartum infections in women and, less commonly, cellulitis, bacteremia, and endocarditis in adults

  • Viridans streptococci

    • Nonhemolytic or α-hemolytic (ie, producing a green zone of hemolysis on blood agar)

    • Leading cause of native valve endocarditis

  • Group D streptococci

    • Include Streptococcus gallolyticus (bovis) and the enterococci

    • S gallolyticus (bovis) is a cause of endocarditis in association with colorectal cancer or cirrhosis

Diagnosis

  • Culture of affected site or blood

Treatment

  • Non-group A hemolytic streptococci (eg, groups B, C, and G)

    • The treatment of infections caused by these non-group A streptococci is similar to treatment of group A streptococci

  • Group B streptococci

    • Penicillin or vancomycin in doses recommended for treatment of group A streptococci skin and soft tissue infections (Table 33–1)

    • Addition of low-dose gentamicin, 1 mg/kg every 8 hours is recommended by some experts because of in vitro synergism

    • Peripartum antimicrobial prophylaxis is recommended

  • See Endocarditis, Infective

Table 33–1.Treatment of common skin and soft tissue infections (SSTIs).
View Table||Download (.pdf)
Table 33–1. Treatment of common skin and soft tissue infections (SSTIs).
SSTI Type Common Pathogens Treatment
Purulent (abscess, furuncle, carbuncle, cellulitis with purulence) Staphylococcus aureus

Incision and drainage is the primary treatment

Consider the addition of antibiotics in select situations1

Oral antibiotic regimens2

 Dicloxacillin 500 mg four times daily or cephalexin 500 mg four times daily

 Clindamycin 300 four times daily or 450 mg three times daily or trimethoprim-sulfamethoxazole one double-strength tablet twice daily or doxycycline (or minocycline) 100 mg twice daily

Intravenous antibiotic regimens2

 Nafcillin 1–2 g four to six times daily or cefazolin 1 g three times daily

 Vancomycin 1 g twice daily or daptomycin 4 mg/kg once daily
Nonpurulent (cellulitis, erysipelas) Beta-hemolytic streptococci (S aureus less likely)

Oral antibiotic regimens2

 Amoxicillin 500 mg three times daily or 875 mg twice daily

 Cephalexin 500 mg four times daily or clindamycin 300 mg four times daily2

Intravenous antibiotic regimens2

 Nafcillin 1–2 g four to six times daily or cefazolin 1 g three times daily

 Vancomycin 1 g twice daily or daptomycin 4 mg/kg once daily

1Antibiotic therapy should be given in addition to incision and drainage for purulent SSTIs if the patient has any of the following: severe or extensive disease, symptoms and signs of systemic illness, purulent cellulitis/wound ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close