Tx GAS & S. pneumoniae IE

Note

These organisms are not common causes of endocarditis and tend to have an aggressive course with complications.

S. pneumoniae IE is often associated with pneumonia and/or meningitis.

Treatment choice should be guided by susceptibilities and involved tissue compartments, with input from Infectious Diseases.

Duration of Therapy

4 weeks for native valve from negative blood culture.

Longer for prosthetic valve endocarditis - consider 6 weeks

Suggested Regimen

Penicillin 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

Cefazolin 2g IV q8h

OR

Ceftriaxone 2g IV q24h

Non-Anaphylactic Penicillin Allergy

Ceftriaxone 2g IV daily

Penicillin Anaphylaxis

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.

Review nature of allergy and consider desensitization procedure for a penicillin/cephalosporin (optimal therapy)

Desensitization procedure