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Antimicrobials
Streptococcus gallolyticus (formerly known as Streptococcus bovis) is associated with colon cancer. Strongly consider Gastroenterology consultation and colonoscopy.
The following regimen applies only to gentamicin susceptible isolates. Strongly consider consultation with Infectious Diseases.
Six weeks
The course starts from the first negative blood culture, and may require alteration if complications occur or the patient requires surgery/valve replacement
Penicillin G 4 million units IV q4h x 6 weeks
OR
Ceftriaxone 2g IV q24h x 6 weeks
WITH
Gentamicin 3mg/kg IV q24h (trough <1µg/mL) x 6 weeks
The following regimen applies only to gentamicin sensitive isolates.
If the isolate is resistant to gentamicin, discuss alternative synergy agents with Infectious Diseases
Vancomycin 25mg/kg IV load followed by 15mg/kg IV maintenance for a target trough of 15-20mg/L, x 6 weeks
View vancomycin nomogram
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.
