Pen (S) and Gent (S)

Normal Renal Function

The regimen below is recommended for patients with CrCl > 50 mL/min

**Duration:

Native Valve

4 - 6 weeks

Prosthetic Valve

Minimum 6 weeks

Gentamicin 1 mg/kg IV/IM q8h

PLUS EITHER

Ampicillin 2 g IV q4h

OR

Penicillin G 18-30 million units per 24 hr either continuously or in 6 equally divided doses

Decreased Renal Function

The regimen below is recommended for patients with CrCl < 50 mL/min initially or those that develop during therapy with a gentamicin-containing regimen.

Duration: 6 weeks

Ampicillin 2 g IV q4h

PLUS

Ceftriaxone 2 g IV q12h

Vancomycin Regimen

Reserved for patients unable to tolerate ampicillin or penicillin.

Duration: 6 weeks

Vancomycin 15-20 mg/kg IV q8-12h

Dose should be adjusted to obtain

serum trough levels of 15-20 mg/L. Peak levels are not routinely indicated.

PLUS

Gentamicin 1 mg/kg IV/IM q8h

Should not be administered to patients with CrCl under 30 mL/min.