Infective endocarditis tx options

Staph native MSSA/MSSE

Naf/oxcillin 2 g Q4H x 6 wks

Cefazolin 2 g Q8H x 6 wks

Staph native MRSA/MRSE

Vanco 15 mg/kg Q12H x 6 wks

Dapto 8 mg/kg Q24H x 6 weeks

Staph PVE MSSA/MSSE

Naf/oxcillin 2 mg/kg Q4H x 6 wks

+/- Rifampin 300 mg Q8H x 6 wks

+/- Gentamicin 3 mg/kg Q24H x 2 wks

Staph PVE MRSA/MRSE

Vanco 15 mg/kg Q12H x 6 wks

+/- Rifampin 300 mg Q8H x 6 wks

+/- Gentamicin 1 mg/kg Q8H x 2 wks

Strep native <0.12

Pen G 12-18 mil Q24H x 4 wks OR

Ceftriaxone 2 g Q24H x 4 wks

+/- Gentamicin 3 mg/kg Q24H x 2 wks

Strep native 0.12 < MIC <0.5

Pen G 24 mil Q24H x 4 wks OR

Ceftriaxone 2 g Q24H x 4 wks

+/- Gentamicin 3 mg/kg Q24H x 2 wks

Strep native <0.5

Ampicillin 2 g IV Q4H x 4 wks

Pen G 24 mil, ceftriaxone, gent, vanco

Strep PVE <0.12

Pen G 12-18 --> 24 mil

Ceftriaxone, gent, vanco

Strep PVE relative and resistant

Pen G 24 mil or ceftriaxone

+/- gent 3 mg/kg Q24H x 6 wks

Enterococcus N/P susceptible

Ampicillin 2g Q4H x 4-6 wks OR

Pen G 24 mil x 4-6 wks

+/- Gent 300 Q24H divided into 2-3 doses

Enterococcus N/P resistant

Vanco x 6 wks

+/- Gent 1 mg/kg Q8H x 6 wks

Entercoccus aminoglycoside/vanco resistant

Linezolid 600 mg Q12 x 6 wks

Dapto 8 mg/kg Q24 H x 6 wks