From the FDA Drug Label
Serious infections, such as pneumonia and endocarditis, due to susceptible strains of streptococci (including S pneumoniae) and meningococcus 150,000 - 300,000 units/kg/day divided in equal doses every 4 to 6 hours; duration depends on infecting organism and type of infection
The recommended treatment for Strep (Streptococcus) agalactiae bacteremia is penicillin G (IV) at a dose of 150,000 - 300,000 units/kg/day divided in equal doses every 4 to 6 hours. The duration of treatment depends on the infecting organism and type of infection 1.
- Key points:
- Penicillin G (IV) is the recommended treatment
- Dose: 150,000 - 300,000 units/kg/day
- Administration: divided in equal doses every 4 to 6 hours
- Duration: depends on the infecting organism and type of infection
From the Research
The recommended treatment for Streptococcus agalactiae bacteremia is intravenous penicillin G at a dose of 4 million units every 4 hours for at least 10-14 days. For patients with penicillin allergy, ceftriaxone 2g IV daily or vancomycin 15-20 mg/kg IV every 8-12 hours (adjusted based on levels and renal function) can be used as alternatives 2. In cases of endocarditis or meningitis associated with the bacteremia, treatment duration should be extended to 4-6 weeks or 2-3 weeks, respectively. Blood cultures should be repeated to ensure clearance of the infection, and the source of bacteremia (such as urinary tract, skin, or endocarditis) should be identified and addressed. Supportive care including fluid management and antipyretics may be necessary.
Key Considerations
- Penicillin remains the first-line treatment because S. agalactiae is highly susceptible to beta-lactam antibiotics, which inhibit bacterial cell wall synthesis 3.
- In pregnant women with S. agalactiae bacteremia, prompt treatment is crucial to prevent complications for both mother and fetus, and consultation with obstetrics is recommended.
- The increasing resistance rate to erythromycin and clindamycin might give a rise to a new epidemiological situation, making them less suitable as empirical therapy in patients allergic to penicillin 4.
Treatment Alternatives
- Ceftriaxone 2g IV daily
- Vancomycin 15-20 mg/kg IV every 8-12 hours (adjusted based on levels and renal function)
Special Considerations
- Endocarditis or meningitis associated with the bacteremia require extended treatment duration
- Pregnant women with S. agalactiae bacteremia require prompt treatment and consultation with obstetrics
- Patients with penicillin allergy require alternative treatments, such as ceftriaxone or vancomycin 2, 5.