Tx GAS & S. pneumoniae IE

Note

These organisms are not common causes of endocarditis and tend to have an aggressive course with complications.

S. pneumoniae IE is often associated with pneumonia and/or meningitis.

Treatment choice should be guided by susceptibilities and involved tissue compartments, with input from Infectious Diseases.

Duration of Therapy

4 weeks for native valve from negative blood culture.

Longer for prosthetic valve endocarditis - consider 6 weeks

Suggested Regimen

Penicillin 4MU IV q4h

OR

Cefazolin 2g IV q8h

OR

Ceftriaxone 2g IV q24h

Non-Anaphylactic Penicillin Allergy

Ceftriaxone 2g IV daily

Penicillin Anaphylaxis

Vancomycin 25-30mg/kg IV load (max 2g) followed by 15mg/kg IV q12h maintenance for a target trough of 15-20µg/mL

Review nature of allergy and consider desensitization procedure for a penicillin/cephalosporin (optimal therapy)

Desensitization procedure