PVE Tx MSSA | Spectrum

Consults

Consult Infectious Diseases

S. aureus infections of prosthetic valves frequently require surgical intervention for cure - Consult Cardiovascular Surgery

Duration of Therapy

MSSA prosthetic valve endocarditis is treated for at least SIX weeks from the first negative blood culture

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

Cloxacillin 2g IV q4h x SIX weeks

AND

Rifampin (IF SUSCEPTIBLE) 300mg PO q8h x SIX weeks.

Multiple drug interactions; Pharmacy consult recommended.

AND

Gentamicin (IF SUSCEPTIBLE) 1mg/kg q8h (trough 1-2µg/mL) x TWO weeks

Non-Anaphylactic Penicillin Allergy

Cefazolin 2g IV q8h INSTEAD OF Cloxacillin in above regimen

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.