Native Strep MIC 0.12-0.5

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

4 weeks for the beta-lactam backbone and 2 weeks of Gentamicin

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) x TWO weeks

AND EITHER

Penicillin G 4MU IV q4h x FOUR weeks

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

Ampicillin IV 2g q4h is a reasonable alternative if penicillin shortage exists

OR

Ceftriaxone 2g IV daily x FOUR 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/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

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.