Endocarditis Culture Results Unavailable

Note: If patient condition permits, cultures should be obtained before initiating antimicrobial therapy

Infective endocarditis—native valve Regimen A (Note three drug therapy) Penicillin G 3.5 million units IV q4h [B] OR Ampicillin 2 g IV q4h [B] PLUS

Nafcillin 2 g IV q4h [B] PLUS

Gentamicin (Garamycin) 2 mg/kg IV loading dose, then 1.7 mg/kg IV q8h (monitor serum levels) [D] Regimen B (Note two drug therapy)

Vancomycin (Vancocin) 15 mg/kg IV q12h (max 1 g/dose; monitor serum levels) [C] PLUS

Gentamicin (Garamycin) 2 mg/kg IV loading dose, then 1.7 mg/kg IV q8h (monitor serum levels) [D] Organisms: Strep viridans, Strep sp., enterococci, Staph sp.

Infective endocarditis—prosthetic valve (Note three drug therapy) Vancomycin (Vancocin) 15 mg/kg IV q12h (max 1 g/dose; monitor serum levels) [C] PLUS

Gentamicin (Garamycin) 2 mg/kg IV loading dose, then 1.7 mg/kg IV q8h (monitor serum levels) [D] PLUS

Rifampin (Rimactane) 600 mg PO qd [C]

Organisms: Staph epidermidis, Staph aureus, Strep viridans, enterococci

1. Infective endocarditis—intravenous drug abusers (Note two drug therapy) Nafcillin 2 gram IV q4h [B] (preferred) OR if penicillin allergic or suspect MRSA

Vancomycin (Vancocin) 15 mg/kg IV q12h (max 1 g/dose; monitor serum levels) [C] PLUS

Gentamicin (Garamycin) 2 mg/kg IV loading dose, then 1.7 mg/kg IV q8h (monitor serum levels) [D] Organisms: S. aureus, gram-negative bacilli Endocarditis Prophylaxis Prophylaxis is recommended for patients with

1. High risk conditions: prosthetic valves, previous history of endocarditis, congenital heart disease (e.g., transposition or tetralogy), pulmonic shunts/conduits OR

2. Moderate risk conditions: cardiomyopathy, mitral prolapse with regurgitation

AND undergoing the following procedures: Dental procedures (excluding filling cavities, suture removal, orthodontic removal or adjustment, or dental x-rays), rigid bronchoscopy, sclerotherapy of esophageal varices, dilation of esophageal strictures, biliary tract or intestinal surgery, prostatic surgery, cystoscopy, and urethral dilatation.

In general, prophylaxis is not recommended for

1. Low risk conditions: ASD or repaired ASD/VSD, PDA beyond 6 months old, mitral valve prolapse without regurgitation/insufficiency, history of CABG, history of rheumatic fever without valve dysfunction, cardiac pacemakers or AICDs.

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