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Background:

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Anaerobic Gram-Negative cocci
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Veillonella
1] Veillonella parvula
2] V. atypica, V. dispar, and V. montpellierensisVeillonella:

  • Gram-negative anaerobic cocci.
  • Well known for its lactate fermenting abilities.
  • Normal bacterium in the intestines and oral mucosa of mammals.
  • Have been rarely implicated in cases of osteomyelitis and endocarditis  (e.g. Veillonella parvula.)
  • Source: https://en.wikipedia.org/wiki/Veillonella

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Therapy:

Important considerations:  The choice of an agent should be based on local antimicrobial sensitivities, site of infection, cost, and comorbid conditions.   Generally, the most common agents/regimens are listed first.

Very little is known about the virulence factors or treatment strategies for this rare pathogen.
Penicillin was considered to be the antimicrobial agent of choice, however, high levels of resistance have been reported in some cases.  Veillonella strains are usually isolated as part of a polymicrobial process.

Veillonella is resistant to the following antimicrobials:

  • Vancomycin
  • Tetracycline
  • Aminoglycosides
  • Ciprofloxacin

Possible treatment regimens -  Check MIC's before treating:

  1. Amoxicillin 500mg orally three times daily or Ampicillin 1-2 grams IV every 4-6 hours
  2. Augmentin 875/125 mg orally twice daily  OR  Ampicillin-sulbactam (Unasyn®) 1.5 - 3.0 grams IV q6h
  3. Metronidazole 500mg IV/PO every 6 hours
  4. Cefoxitin 1-2 gm IV q6h
  5. Clindamycin  Usual: 600-900mg IV every 6 or 8 hours or 150 to 450mg orally every 6-8 hours
  6. Chloramphenicol 50-100 mg/kg/day IV in divided doses every 6 hours (Maximum daily dose is 4 grams e.g. 1 gram q6h)

Reference(s)

Veillonella