Antibiotic treatment of streptococcal and enterococcal endocarditis: an overview

The management of streptococcal and enterococcal endocarditis has changed in recent years with the development of effective new regimens that are easier to administer, but resistance to commonly used antibiotics has appeared, especially among enterococci. Beta-lactam antibiotics either alone or in combination are suitable for most patients with viridans streptococci. Streptococci bovis, and S. pneumoniae, but alternative regimens are necessary for special situations. Group B, C and G streptococci respond best to the combination of a penicillin and an aminoglycoside. Enterococci are relatively resistant to penicillins and cephalosporins and strains resistant to beta-lactams, glycopeptides and aminoglycosides have become more common lately. Strategies are proposed dependent on the resistance of the organisms, but it is recognized that medical failure is not uncommon and surgical removal of the infected valve may be the only curative treatment.