LAB WORK
  • Gram +, beta-hemolytic (complete hemolysis)

TREATMENT
  • Penicillin, ampicillin (virtually all strains susceptible, BUT confirm with sensitivities)
  • Second Line: 
    • Cefazolin
    • Vancomycin
    • Fluoroquinolones
  • Agents with variable activity (avoid due to rising resistance, confirm with sensitivities) :
    • ​Tetracyclines
    • Clindamycin
    • Macrolides
    • Bactrim

CLINICAL NOTES
  • Durations of Therapy
    • Bacteremia/soft tissue = 10-14 days
    • Meningitis = 14-21 days
    • Osteomyelitis = 3-4 weeks
    • Endocarditis =  4-6 weeks
  • Female GU colonizer and lower GI
    • Prevention of vertical transmission in pregnancy: Pen G 5 MU x 1, then 2.5 MU q4h until delivery
      • If penicillin allergy, stratify by anaphylaxis risk
        • Low risk (no hives or angioedema): Cefazolin 2 g x 1, then 1g IV q8h until delivery
        • High risk: Vancomycin 15 mg/kg IV q12h until delivery