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Antimicrobials
Enterococcal IE is generally treated for SIX weeks, and maybe longer for prosthetic valves
The course starts from the first negative blood culture, and may require alteration if complications occur or the patient requires surgery/valve replacement
Alternative synergistic agent given Gentamicin resistance - i.e. Streptomycin.
Discuss with ID.
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 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 + Aminoglycoside
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
