Prosthetic Valve IE: Empiric ABx

Prior to starting antimicrobials

Ensure adequate blood culture data collected.

Suggested Regimen

Vancomycin IV loading dose followed by maintenance for target trough of 15-20 ug/mL
see dosing nomogram

If patient cannot be dosed using nomogram
contact Pharmacy.

AND

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

AND

Rifampin 300mg PO q12h
*multiple drug interactions, including warfarin.
Pharmacy consult recommended

Simultaneous treatment with vancomycin and gentamicin markedly increases risk of nephrotoxicity relative to either agent alone; Pharmacy consult recommended