Native Valve Endocarditis - Indolent presentation

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

First Line

Therapy

Amoxicillin 2g IV 4 hourly AND Gentamicin 1mg/kg IV 12-hourly (synergistic dose - up to a maximum of 120mg 12-hourly)

 

Notes:

If acute kidney injury, replace Gentamicin with Ciprofloxacin 750mg PO 12 hourly or 400mg IV 8hourly (consider safety issues)

Penicillin Allergy

Therapy

Vancomycin IV as per protocol AND Gentamicin IV as per protocol (Treatment dose)

 

Notes:

If acute kidney injury, replace Gentamicin with Ciprofloxacin 750mg PO 12 hourly or 400mg IV 8hourly (consider safety issues)

If true vancomycin allergy, replace with Daptomycin 6mg/kg IV daily (monitor CK)

 

Notes

Prescribe on HEPMA using the file: 'Gentamicin IV STAT / Endocarditis / Synergy / Nebulised' specifying the dose (e.g. 80mg BD)
Aim for a 1 hour post dose peak of 3-5 mg/L and a trough of <1 mg/L
Take a first peak level 1 hour after the first dose and the first trough level immediately prior to second dose. Ensure the dosing & sample time are recorded accurately. 
Doses should be given by IV bolus injection over 3-5 minutes.

If renal function is poor or deteriorating, discuss dosing and frequency with pharmacist ASAP