Please note: This is for information only.

Refer to local guidelines for treatment recommendations

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• Gram-positive cocci, in pairs or chains.

Main pathogens are:

• Group A streptococcus (S. pyogenes)
• Group B streptococcus (S. agalactiae)
• S. pneumoniae (pneumococcus)
• Viridans streptococci (endocarditis)

Main clinical manifestations:

• Group A strep.
• Tonsillitis
• Wound infection
• Cellulitis
• Necrotising fasciitis
• Puerperal sepsis (now rare)
• Septicaemia
• Recent increase in incidence in intravenous drug users.
• Group B strep.
• UTI
• neonatal sepsis
• endocarditis
• Increase risk in diabetics.
• S. pneumoniae
• pneumonia
• meningitis
• bone/joint infections
• Increased risk in asplenia/myeloma.

Usually sensitive to:

• Penicillin
• NOTE: increase in acquired resistance to penicillin (more common in other European countries than in UK).
• Cephalosporins
• Macrolides (erythromycin, clarithromycin) (acquired resistance common)
• Glycopeptides (vancomycin, teicoplanin)

Usually resistant to:

• Ciprofloxacin
• Gentamicin (unless in combination with penicillin / glycopeptides)
• Trimethoprim