Native Strep MIC <0.12

Notes

There are two options for therapy - two weeks or four weeks

Streptococcus bovis (Group D Strep) now called Streptococcus gallolyticus associated with colon cancer - patient should have colonoscopy

2 Week Therapy Option

This option may be selected for patients <65 with good renal and auditory function, with no abscess or extracardiac infection and when the isolate is susceptible to Gentamicin

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*

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

OR

Ceftriaxone 2g IV daily

Duration: 2 weeks from negative blood culture if no other indication for longer course and no valve replacement/surgery required

4 Week Therapy Option

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*

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

OR

Ceftriaxone 2g IV daily

Duration: 4 weeks from first negative blood culture. If patient requires valve replacement, alterations in therapy may be necessary

Non-Anaphylactic Penicillin Allergy

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.

This regimen requires 4 weeks of therapy (no two week option), with or without gentamicin

Review nature of allergy and consider desensitization procedure for a beta-lactam (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.