Peptostreptococcus Infection Treatment & Management

Updated: Apr 30, 2021
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Michael Stuart Bronze, MD  more...
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Medical Care

A patient's recovery from anaerobic infection depends on prompt and proper treatment according to the following principles: (1) neutralizing toxins produced by anaerobes, (2) preventing local bacterial proliferation by changing the environment, and (3) limiting the spread of bacteria.

Control the environment by debriding necrotic tissue, draining pus, improving circulation, alleviating obstruction, and increasing tissue oxygenation. Certain types of adjunctive therapy, such as hyperbaric oxygen therapy, may be useful but remain unproven.

In many cases, antimicrobial therapy is the only form of therapy required, but it can also be an adjunct to a surgical approach. Because anaerobic bacteria, including peptostreptococci, are generally recovered mixed with aerobic organisms, choose antimicrobial agents that treat both types of pathogens, taking into consideration their aerobic and anaerobic antibacterial spectrum and their availability in oral or parenteral form. [30, 31]

Penicillin G is most effective for treating anaerobic gram-positive cocci and microaerophilic streptococci. Other effective agents include other penicillins, cephalosporins, chloramphenicol, clindamycin, vancomycin, telithromycin, linezolid, quinupristin/dalfopristin, and carbapenems.

The efficacy of macrolides (eg, erythromycin) and imidazoles (eg, metronidazole) is variable and unpredictable. Imidazoles are ineffective against some anaerobic gram-positive cocci and all aerotolerant strains.

The newer quinolones are effective against more than 90% of anaerobic cocci; ciprofloxacin is less effective.

Occasionally, certain strains are resistant to antimicrobials, especially after administration of these agents.

When mixed with other beta-lactamase–producing bacteria, anaerobic gram-positive cocci and microaerophilic streptococci may survive penicillin or cephalosporin therapy because of the protection provided by the free enzyme. In such instances, antimicrobials with wider spectrums of activity may be more effective.


Surgical Care

In most cases, surgical therapy is critically important. Surgical therapy includes (1) draining abscesses,(2) debriding necrotic tissues, 3) decompressing closed-space infections, and (4) relieving obstructions. [32] If surgical drainage is not used, the infection may persist and serious complications may develop.