Native/Prosth Strep MIC >0.5

Notes

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

Both drugs (beta-lactam AND Gentamicin) for SIX weeks.

Prosthetic valve may require longer.

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

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

AND EITHER

Penicillin G 4MU IV q4h

PEN G FOR IV INFUSION IS NOT THE SAME AS THE LONG ACTING BENZATHINE IM FORMULATION
; DOUBLE CHECK WHEN ORDERING OR DISPENSING*

OR

Ampicillin 2g IV q4h

Penicillin Allergy

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.