Native Strep MIC 0.12-0.5

Notes

The following regimen applies only to gentamicin sensitive isolates.

If the isolate is resistant to gentamicin, discuss alternative synergy agents with Infectious Diseases

Duration of Therapy

4 weeks for the beta-lactam backbone and 2 weeks of Gentamicin

The course starts from the first negative blood culture, and may require alteration if complications occur or the patient requires surgery/valve replacement

Suggested Regimen

Gentamicin 3mg/kg IV q24h (trough <1µg/mL) x TWO weeks

AND EITHER

Penicillin G 4MU IV q4h x FOUR weeks

OR

Ceftriaxone 2g IV daily x FOUR weeks

Non-Anaphylactic Penicillin Allergy

Choose Ceftriaxone 2g IV daily INSTEAD of Penicillin in above regimen

Penicillin Anaphylaxis

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/Ceftriaxone 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.