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Antimicrobials
Enterococcal IE is generally treated for SIX weeks, and maybe longer for prosthetic valves
4 weeks may be considered for a NATIVE valve if <3 months of symptoms prior to therapy, and using a beta-lactam as therapeutic backbone
Gentamicin is generally continued for the duration of therapy but needs to be weighed against toxicities
The course starts from the first negative blood culture, and may require alteration if complications occur or the patient requires surgery/valve replacement
Gentamicin 1mg/kg IV q8h (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
Ampicillin generally more active than pen G vs enterococci and is the preferred agent if both are available
Vancomycin IV loading dose followed by maintenance for target trough of 15-20 ug/mL INSTEAD of penicillin/ampicillin 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, and penicillins are superior 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.
