Prosthetic Heart Valve Endocarditis

First Line

Important: Therapy

Vancomycin IV as per protocol AND Gentamicin 1mg/kg IV 12-hourly (synergistic dose - up to a maximum of 120mg 12-hourly) AND Rifampicin 600mg PO 12 hourly

Notes:

Reduce dose of rifampicin to 300mg 12 hourly if creatinine clearance <30ml/min.

If oral route for rifampicin not available then use same dose IV.

Important: Notes

Prescribe synergistic gentamicin 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