Spectrum: Local Antimicrobial Stewardship, for Saskatchewan Health Authority - Saskatoon Area

Enterococcal IE Amp R / Gent S

Duration of Therapy

Enterococcal IE is generally treated for SIX weeks.

Gentamicin is generally continued for the duration of therapy but needs to be weighed against toxicities. Monitor for nephrotoxicity and otovestibular toxicity.

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

Strongly consider Infectious Diseases consultation

Suggested Regimen

Vancomycin 25mg/kg IV load followed by 15mg/kg IV maintenance for a target trough of 10-20mg/L, with the addition of gentamicin as above.

View vancomycin nomogram

AND

Gentamicin 1mg/kg IV q8h (trough <1µg/mL)

This regimen has significant risk of nephrotoxicity and otovestibular toxicity; close monitoring required. Strongly consider Infectious Diseases consultation.