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Antimicrobials
This therapy also applies to Abiotrophia, Granulicatella, Gemella
The following regimen applies only to gentamicin sensitive isolates.
If the isolate is resistant to gentamicin, discuss alternative synergy agents with Infectious Diseases
Both drugs (beta-lactam AND Gentamicin) for SIX weeks.
Prosthetic valve may require longer.
The course starts from the first negative blood culture, and may require alteration if complications occur or the patient requires surgery/valve replacement
Gentamicin 3mg/kg IV q24h (trough <1µg/mL)
AND EITHER
Penicillin G 4MU IV q4h
OR
Ampicillin 2g IV q4h
Vancomycin 25-30mg/kg IV load (max 2g) followed by 15mg/kg IV q12h maintenance for a target trough of 10-15µg/mL INSTEAD OF Penicillin/Ampicillin in above regimen
Review nature of allergy and consider desensitization procedure as increased risk of nephrotoxicity with Vancomycin + Gentamicin
Desensitization procedure
Drug to which patient has an immediate hypersensitivity reaction, is administered in increasing increments to allow TEMPORARY tolerance of the drug for a period of required therapy.
Day 3 Bundle
