I have seen a 72 year old diabetic man who has Streptococcus anginosus in his blood cultures. He presented with fever, general malaise and weight loss. He is going to have an echocardiogram and his doctor is very concerned about endocarditis. He is being treated with ceftriaxone 2 grams Q24H and Vancomycin 1g Q12H. What is the appropriate therapy?
Firstly, he needs a specific diagnosis. The finding of S. anginosus in blood cultures is very suggestive of an abscess in an organ, most commonly in the liver. He needs a CT scan of his abdomen for a start. As far as therapy is concerned, S. anginosus tend to be susceptible to most antibiotics. Penicillin G is the “tried and true” therapy though difficult to administer. Ceftriaxone is almost certainly active and facilitates outpatient completion of therapeutic course.