Enterococcal IE: Amp S/Gent S

Duration of Therapy

Enterococcal IE is generally treated for SIX weeks, and maybe longer for prosthetic valves

4 weeks may be considered for a NATIVE valve if <3 months of symptoms prior to therapy, and using a beta-lactam as therapeutic backbone

Gentamicin is generally continued for the duration of therapy but needs to be weighed against toxicities

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 1mg/kg IV q8h (trough <1µg/mL)

AND EITHER

Penicillin G 4MU IV q4h

OR

Ampicillin 2g IV q4h

Penicillin Allergy

Vancomycin 25-30mg/kg IV load (max 2g) followed by 15mg/kg IV q12h maintenance for a target trough of 15-20µg/mL INSTEAD OF Penicillin/Ampicillin in above regimen

Review nature of allergy and consider desensitization procedure as increased risk of nephrotoxicity with vancomycin + gentamicin, and penicillins are superior therapy.

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.