Spectrum: Local Antimicrobial Stewardship, for Eastern Health

NVE Tx CoNS (Clox S)

Notes

Native valve coagulase negative Staphylococcal endocarditis does occur but is uncommon.

It is more likely in the setting of underlying valve pathology.

Duration of Therapy

4-6 weeks from first negative blood culture.

If valve replacement required, therapy may need to be altered to reflect prosthetic valve endocarditis.

Suggested Regimen

Cloxacillin 2g IV q4H

Non-Anaphylactic Penicillin Allergy

Cefazolin 2g IV q8h

Penicillin Anaphylaxis

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

If patient cannot be dosed using nomogram
contact Pharmacy.

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.