Native Strep MIC 0.12-0.5

Notes

Streptococcus gallolyticus (formerly known as Streptococcus bovis) is associated with colon cancer. Strongly consider Gastroenterology consultation and colonoscopy.

Duration of Therapy

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

Penicillin G 4 million units IV q4h x 4 weeks

OR

Ceftriaxone 2g IV daily x 4 weeks

WITH

Gentamicin 3mg/kg IV q24h (trough <1µg/mL) x first 2 weeks

The following regimen applies only to gentamicin sensitive isolates.

If the isolate is resistant to gentamicin, discuss alternative synergy agents with Infectious Diseases

Non-Anaphylactic Penicillin Allergy

Choose Ceftriaxone 2g IV daily x 4 weeks, with gentamicin added for first two weeks (as above)

Penicillin Anaphylaxis

Vancomycin 25mg/kg IV load followed by 15mg/kg IV maintenance for a target trough of 10-15mg/L

This regimen requires 4 weeks of therapy (no two week option) without addition of gentamicin.

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.