Group D Streptococcus (GDS) Infections (Streptococcus bovis/Streptococcus gallolyticus) Treatment & Management

Updated: Mar 02, 2021
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Medical Care

Most S bovis isolates are susceptible to penicillin (MIC ≤ 0.1 mg/L) and should be treated with intravenous penicillin G or ceftriaxone for 4 weeks. An alternative for only uncomplicated cases of native-valve endocarditis is a 2-week course of therapy with a combination of penicillin G or ceftriaxone and gentamicin. For moderately susceptible isolates (MIC >0.1 mg/L, MIC ≤ 0.5 mg/L), penicillin or ceftriaxone and gentamicin should be administered for 4 weeks and 2 weeks, respectively. [16]


Surgical Care

Surgical valve replacement is indicated in some cases, particularly for heart failure or complications of endocarditis (see Complications).

Mycotic aneurysm clipping after cerebral arteriography may be indicated.

Based on the findings from the evaluation of the gastrointestinal tract, colon or hepatobiliary surgery may be indicated.



Consult an infectious diseases specialist to confirm the diagnosis of Streptococcus group D infection and to recommend treatment for endocarditis or bacteremia.

Consult a cardiologist to evaluate heart function, including echocardiography findings.

A cardiovascular surgeon can assist with valvular replacement, if indicated. Having the cardiac surgeon involved from the start is a good practice in case the patient's heart condition abruptly deteriorates.

Obtain a consultation with a neurosurgeon for possible clipping if mycotic aneurysms are present.

Obtain a consultation with a general surgeon or gastroenterologist to investigate and treat colonic or hepatobiliary disease.