Prosthetic Valve IE - MSSA Treatment

Consults

Strongly consider Cardiology and Infectious Diseases consultation.

Prosthetic valve infective endocarditis secondary to Staphylococcus aureus frequently require surgical intervention for cure. Strongly consider Cardiovascular Surgery consultation.

Duration of Therapy

MSSA prosthetic valve endocarditis is treated for at least SIX weeks from the first negative blood culture.

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

Cloxacillin 2g IV q4h x 6 weeks

AND

Rifampin 300mg PO q8h x 6 weeks

AND

Gentamicin 1mg/kg q8h (trough 1-2µg/mL) x TWO weeks

Non-Anaphylactic Penicillin Allergy

Cefazolin 2g IV q8h, with the addition of rifampin and gentamicin as above.

Penicillin Anaphylaxis

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

Review nature of allergy and consider desensitization procedure for a penicillin/cephalosporin (optimal 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.