Endocarditis

Antimicrobial prescribing: NHS Grampian, Orkney & Shetland
NHS Grampian

Duration

Total duration is 4 to 6 weeks - depending on organism, patient characteristics, presence of prosthetic valve, etc

Notes

Therapy

  • Always take blood for culture before starting treatment - 2 to 3 sets over 2 - 24 hours (>6 hours apart ideally) and as close as possible to peak of pyrexia
  • See national BSAC guidance for additional information 
  • Consult with infectious diseases specialist and medical microbiologist about organism specific therapy and consider need for urgent surgical intervention.

Notes:

Native Valve Indolent presentation

Therapy

IV Amoxicillin 2g 4 hourly

+ (optional)

IV Gentamicin as per synergistic dosing guideline (low threshold for discontinuing once organism identified - seek microbiology advice)

 

Notes:

Check gentamicin levels regularly, modify according to renal function.

Pre-dose (trough ) <1mg/L and peak (1 hour post-dose) 3-5mg/L

Native Valve Severe sepsis, Acute presentation, or penicillin allergy

Therapy

Vancomycin IV as per guideline

Use calculator for intermittent dosing

+

IV Gentamicin as per synergistic dosing guideline

 

Notes:

Check gentamicin levels regularly, modify according to renal function.

Pre-dose (trough ) <1mg/L and peak (1 hour post-dose) 3-5mg/L

 

Check vancomycin levels regularly:

Pre-dose (trough) level of 15-20mg/L

Prosthetic Valve

Therapy

Vancomycin IV as per guideline

Use calculator for intermittent dosing

+

IV Gentamicin as per synergistic dosing guideline

+

Oral / IV Rifampicin 300-600mg 12 hourly

Notes:

Rifampicin helps eradicate bacteria attached to prosthetics.

Check gentamicin levels regularly, modify according to renal function.

Pre-dose (trough ) <1mg/L and peak (1 hour post-dose) 3-5mg/L

 

Check vancomycin levels regularly:

Pre-dose (trough) level of 15-20mg/L