Endocarditis caused by Abiotrophia and Granulicatella species
Management of infective endocarditis caused by Abiotrophia and Granulicatella species (formerly known as nutritionally variant streptococci) should involve a multidisciplinary team-based approach; see Approach to managing infective endocarditis.
Endocarditis caused by Abiotrophia and Granulicatella species is often associated with a complicated course. Susceptibility testing can be difficult; seek advice from a clinical microbiologist or an infectious diseases physician to select the antibiotic regimen.
For principles of antimicrobial therapy for infective endocarditis (including duration of therapy following valve surgery and considerations for ambulatory antimicrobial therapy), see Principles of antimicrobial therapy for infective endocarditis.
For adults and children with endocarditis caused by Abiotrophia and Granulicatella species, a commonly used regimen is:
benzylpenicillin 2.4 g (child: 60 mg/kg up to 2.4 g) intravenously, 4-hourly for 6 weeks. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment benzylpenicillin benzylpenicillin benzylpenicillin
PLUS
gentamicin (adult and child) 1 mg/kg intravenously, 8-hourly for 2 weeks (monitor plasma concentration; see Principles of aminoglycoside use)1. gentamicin gentamicin gentamicin
Alternative regimens include ceftriaxone or vancomycin for 6 weeks, combined with an aminoglycoside for at least the first 2 weeks.