Viridans Strep NVE — SCE Infectious Diseases MCQ

Correct answer: E — Use a 4-week beta-lactam regimen, with a 2-week beta-lactam–gentamicin option principally in carefully selected uncomplicated disease with review after review

The best answer is “Use a 4-week beta-lactam regimen, with a 2-week beta-lactam–gentamicin option principally in carefully selected uncomplicated disease with review after review”. Susceptibility and uncomplicated native-valve anatomy permit standard beta-lactam treatment; the shortened synergistic course has strict eligibility and toxicity constraints. “Use oral amoxicillin alone for 7 days” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use flucloxacillin monotherapy because all streptococci are staphylococci” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use vancomycin for 6 weeks despite no beta-lactam allergy” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Stop treatment when the first repeat blood culture is negative” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

Reference: ESC infective endocarditis guideline 2023: https://academic.oup.com/eurheartj/article/44/39/3948/7243107