Streptococcus monoliformis

Treatment

• Streptococcus moniliformis treatment

• 1. Migratory arthropathy and arthritis

• Preferred regimen (1): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 week, switch to Amoxicillin 1 g q12h PO for 14 days
• Preferred regimen (2): Penicillin Vk 125 to 250 mg (200,000 to 400,000 units) PO q6-8h complete 14 days.

• 2. Diarrhea, (especially kids) liver or spleen abscess

• Preferred regimen (1): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 week, switch to Amoxicillin 1 g q12h PO for 14 days
• Preferred regimen (2): Penicillin Vk 125 to 250 mg (200,000 to 400,000 units) PO q6-8h complete 14 days.

• 3. Undifferentiated fever

• Preferred regimen (1): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 week, switch to Amoxicillin 1 g q12h PO for 14 days
• Preferred regimen (2): Penicillin Vk 125 to 250 mg (200,000 to 400,000 units) PO q6-8h complete 14 days.

• 4. Endocarditis, myocarditis, pericarditis (cardiac)

• Preferred regimen: Penicillin 20 MU/day IV divided q4h for 4 weeks (optimal duration recommendation for infective endocarditis is 4 weeks.)
• Alternative regimen (1): Cephalosporins-Cefdinir 600 mg PO q24h for 10 days -Ceftriaxone 2 g IV/IM q24h for 6 weeks with or without Gentamicin sulfate 3 mg/kg IM or IV in 1 dose (preferred) or in 3 equally divided doses for 2 weeks
• Alternative regimen (2): Clindamycin 600–1200 mg/day IM or IV in 2, 3 or 4 equal doses
• Alternative regimen (3): Erythromycin
• Alternative regimen (4): Chloramphenicol 100 mg/kg/day AND Streptomycin
• Note: In Penicillin-sensitive alpha and non-hemolytic streptococcal endocarditis (Penicillin minimum concentration inhibitory <0.1 mcg/mL)

• Streptomycin may be used for 2-week treatment concomitantly with Penicillin.
• The Streptomycin regimen is 1 g bid for the first week, and 500 mg bid for the second week.
• If the patient is over 60 years of age, the dosage should be 500 mg bid for the entire 2- week period.

• 5. Meningitis, brain abscess

• Preferred regimen: Penicillin 10 MU/day IV divided q4h.
• Alternative regimen (1): Cephalosporins-Cefdinir 600 mg PO q24h for 10 days -Ceftriaxone 2 g IV/IM q24h for 6 weeks with or without Gentamicin sulfate 3 mg/kg IM or IV in 1 dose (preferred) or in 3 equally divided doses for 2 weeks
• Alternative regimen (2): Clindamycin 600–1200 mg/day IM or IV in 2, 3 or 4 equal doses
• Alternative regimen (3): Erythromycin
• Alternative regimen (4): Chloramphenicol 100 mg/kg/day

• 6. Pneumonia

• Preferred regimen (1): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 week, switch to Amoxicillin 1 g q12h PO for 14 days
• Preferred regimen (2): Penicillin Vk 125 to 250 mg (200,000 to 400,000 units) PO q6-8h complete 14 days.

• 7. Amnionitis (pregnancy)

• Preferred regimen (1): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 week, switch to Amoxicillin 1 g q12h PO for 14 days
• Preferred regimen (2): Penicillin Vk 125 to 250 mg (200,000 to 400,000 units) PO q6-8h complete 14 days.

• 8. Renal abscess

• Preferred regimen (1): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 week, switch to Amoxicillin 1 g q12h PO for 14 days
• Preferred regimen (2): Penicillin Vk 125 to 250 mg (200,000 to 400,000 units) PO q6-8h complete 14 days.
• Note: Streptococcus moniliformis also causes anemia.