Enterococcal IE: Amp S/Gent S

Duration of Therapy

Enterococcal IE is generally treated for SIX weeks.

4 weeks may be considered for a NATIVE valve IE secondary to Enterococcus if <3 months of symptoms prior to therapy, and using ampicillin with gentamicin.

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

Suggested Regimen

Ampicillin 2g IV q4h

PLUS

Ceftriaxone 2g IV q12h

OR

Ampicillin 2g IV q4h

PLUS

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

Penicillin Allergy

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.

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.