Prosthetic Strep MIC <0.12

Notes

Streptococcus bovis (Group D Strep) now called Streptococcus gallolyticus associated with colon cancer - patient should have colonoscopy

The following regimen applies only to gentamicin sensitive isolates.

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

Duration of Therapy

At least 6 weeks for the beta-lactam backbone and 2 weeks of Gentamicin

Suggested Regimen

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

AND EITHER

Penicillin G 4MU IV q4h x SIX weeks

OR

Ceftriaxone 2g IV daily x SIX weeks

Non-Anaphylactic Penicillin Allergy

Choose Ceftriaxone 2g IV daily INSTEAD of Penicillin in above regimen

Penicillin Anaphylaxis

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

If patient cannot be dosed using nomogram
contact Pharmacy.

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.