How long do you treat uncomplicated streptococcal bacteremia?

Generally, recent data support 7 days of treatment for non-Staphylococcus aureus bloodstream infection (BSI), if the source is controlled. Overall, I consider in each case what the source of the bacteremia is, and how long I would treat for whatever the source or other resulting entity is first. (For example, if the patient has endocarditis, septic arthritis, osteomyelitis, etc., those things would dictate the treatment duration, which would be longer.) If the source infection is controlled and/or if the syndromic diagnosis is treated for a shorter duration anyway, then I think it is reasonable to treat the bacteremia itself for 7 days; I would also take into account their clinical progress in this as well.

Most cases can be treated with 7 days of therapy. No clear definition exists for uncomplicated streptococcal bacteremia, and no clear guidelines exist.

The BALANCE Study has a good-sized cohort of streptococcal bacteremia patients and is worth reviewing. The study patients were quite sick as well, since many were in the intensive care unit (ICU).

No Infectious Diseases Society of America (IDSA) or any other U.S. guidelines exist on the duration of therapy for gram-positive (non-Staphylococcus aureus) bacteremias. Even community-acquired pneumonia (CAP) guidelines do not address management of bacteremic pneumococcal pneumonia, but data support short courses.