Native Strep MIC <0.12

Notes

There are two options for therapy - two weeks or four weeks

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

4 Week therapy option

Penicillin G 3 million units IV q4h

OR

Ceftriaxone 2g IV daily

Duration: 4 weeks from first negative blood culture. If patient requires valve replacement, alterations in therapy may be necessary

2 Week Therapy Option

This option may be selected for patients <65 with good renal and auditory function, with no abscess or extracardiac infection and when the isolate is susceptible to Gentamicin

Penicillin G 3 million units IV q4h

OR

Ceftriaxone 2g IV daily

WITH

Gentamicin 3mg/kg IV q24h (trough <1µg/mL)

Duration: 2 weeks from negative blood culture if no other indication for longer course and no valve replacement/surgery required

If gentamicin is being considered, strongly recommend ID consultation and monitoring for nephrotoxicity and audio-vestibulotoxicity.

Non-Anaphylactic Penicillin Allergy

Ceftriaxone 2g IV daily x 4 weeks

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 for a beta-lactam (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.