Empirical Antibiotic Therapy in Suspected Infective Endocarditis

Empirical Antibiotic Therapy in Suspected Infective Endocarditis

Patients with prosthetic heart valves, penicillin allergy, suspected MRSA:
- Vancomycin 1g 12-hourly IV plus
- Gentamicin 1 mg/kg 8-hourly IV plus
- Consider adding rifampicin 450 mg 12-hourly PO in prosthetic valve infection
Acute presentation (ill for <1 week) in patients with native valves (including IVDUs):
- Flucloxacillin 2g 4–6 hourly IV plus
- Gentamicin 1 mg/kg 8-hourly IV
Sub-acute presentation in patients with native heart valves:
- Amoxicillin 2g 4-hourly IV plus
- Gentamicin 1 mg/kg 8-hourly IV

These are regimens for when therapy has to be started before blood culture results are available. Contact a microbiologist for advice, particularly in patients with penicillin allergy.

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Table 52.7