Oral step-down therapy for streptococcal bacteremia … it doesn’t have to be a fluoroquinolone!

Reviewed by Cynthia T. Nguyen, PharmD, University of Chicago Medicine

A multicenter, retrospective cohort study of 220 patients demonstrated similarly high rates of clinical success for uncomplicated streptococcal bloodstream infection (BSI) with fluoroquinolone (FQ) and oral beta-lactam (OBL) step-down therapy (93% versus 92%). The most common organisms were S. pneumoniae (34%), S. pyogenes (17%), and S. agalactiae (16%). Most patients in the FQ group had a respiratory source of infection (62%), while skin and skin structure infections were most common in the OBL group (45%). Patients were transitioned to oral therapy after a median of 5.7 days and the median total treatment duration was 14 days. Though the optimal treatment duration for these uncomplicated streptococcal BSIs is unknown, step-down to an OBL is non-inferior to a FQ in patients requiring long duration of therapy.


Arensman K, Shields M, Beganovic M, et al. Fluoroquinolone versus beta-lactam oral step-down therapy for uncomplicated streptococcal bloodstream infections [published online ahead of print, 2020 Aug 24]. Antimicrob Agents Chemother. 2020;AAC.01515-20. doi:10.1128/AAC.01515-20

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