From the Research
The recommended treatment duration for Streptococcus constellatus bacteremia is typically 5-10 days of intravenous antibiotics, depending on the clinical scenario and presence of complications, as supported by the most recent study 1. This duration is based on the study that found no difference in clinical failure between episodes receiving short (5-10 days) and long (11-18 days) courses of antimicrobial treatment for uncomplicated streptococcal bacteraemia 1. Initial therapy should include penicillin G (2-4 million units IV every 4-6 hours) or ceftriaxone (1-2g IV daily) as first-line options, as they are effective against S. constellatus, as shown in studies 2, 3, 4. For penicillin-allergic patients, clindamycin (600-900mg IV every 8 hours) or vancomycin (15-20mg/kg IV every 8-12 hours) are appropriate alternatives, although S. constellatus has shown resistance to clindamycin in some cases 2, 3. Complicated infections involving abscesses, endocarditis, or metastatic spread may require longer treatment duration and surgical intervention to drain any purulent collections. S. constellatus is part of the Streptococcus anginosus group and has a notable propensity to form abscesses, so thorough evaluation for occult abscess formation is essential through appropriate imaging. Blood cultures should be repeated to confirm clearance of bacteremia. Once the patient shows clinical improvement with negative follow-up cultures, consideration can be given to transitioning to oral therapy (amoxicillin 500-875mg three times daily or clindamycin 300-450mg four times daily) to complete the treatment course. Some key points to consider in the treatment of S. constellatus bacteremia include:
- The importance of timely and appropriate antibiotic therapy
- The need for thorough evaluation for occult abscess formation
- The potential for complications, such as endocarditis or metastatic spread
- The importance of repeating blood cultures to confirm clearance of bacteremia
- The potential for transitioning to oral therapy once the patient shows clinical improvement with negative follow-up cultures. It is essential to note that the treatment duration and approach may vary depending on the individual patient's clinical scenario and the presence of complications, and the most recent and highest quality study should be prioritized in making treatment decisions 1.