Important: Therapy
Amoxicillin 2g IV 4 hourly
+ / -
Gentamicin IV Synergistic Dosing see Synergistic Gentamicin for Endocarditis in Adults Guideline
If genuine penicillin allergy, use regimen for NVE severe sepsis
Infective Endocarditis
Duration
Discuss duration with Consultant Microbiologist and Cardiologist
Important: Therapy
Vancomycin IV dosing as per guideline. Use vancomycin calculator.
+
Gentamicin IV Synergistic Dosing see Synergistic Gentamicin for Endocarditis in Adults Guideline
If patients have risk factors for multiresistant Enterobacteriaceae or Pseudomonas, eg. evidence of previous colonisation, use Meropenem 2g 8 hourly in place of Gentamicin.
In severe sepsis, Staphylococci spp. need to be covered. Patients at increased risk of staphylococcal endocarditis include iv drug abusers and patients with intravascular devices.
Important: Therapy
Vancomycin IV dosing as per guideline. Use vancomycin calculator.
+
Rifampicin oral 300mg to 600mg 12 hourly (or IV if oral route unavailable)
(use lower dose of rifampicin in severe renal impairment)
+
Gentamicin IV Synergistic Dosing see Synergistic Gentamicin for Endocarditis in Adults Guideline
Important: Notes
Discussion of all cases of endocarditis (including culture negative) with a Consultant Microbiologist and Cardiologist is strongly advised.
Send three sets of blood cultures, from separate sites, over a 24 hour period if possible. In the acutely ill, two sets should be taken within 1 hour before starting empirical therapy.
Once causative organisms are known antibiotics should be tailored to the organisms isolated following discussion with the Consultant Microbiologist.
Treatment follows the British Society for Antimicrobial Chemotherapy (BSAC) Endocarditis Working Party recommendations 2012.