Spectrum: Local Antimicrobial Stewardship, for Bakersfield Memorial Hospital

Enterococcal Treatment / Infective Endocarditis

Native and Prosthetic Valve (PCN Susceptible Strains)

Ampicillin 2 g IV every 4 hr

Plus

Gentamicin 1 mg/kg IV every 8 hr

OR

Ceftriaxone 2 g IV every 12 hr*

*Recommended for patients with impaired renal function or who are at greater risk of developing nephrotoxicity from aminoglycoside use.

Native and Prosthetic Valve (PCN Resistant Strains)

Vancomycin

PLUS

Gentamicin 1 mg/kg IV every 8 hr

Duration

Patients with NVE and symptoms <3 months may be treated for 4 weeks; patients with PVE or NVE with symptoms ≥3 months should be treated for at least 6 weeks.

For adult patients with gentamicin-susceptible isolates, some experts shorten gentamicin component to two weeks when used in combination with a beta-lactam, particularly with emergence of nephrotoxicity.