Possible Infective Endocarditis

NHSL Antimicrobial Guidelines
NHS Lanarkshire

Native Heart Valve

Therapy

IV Amoxicillin10 2g 4 hourly
+ IV Gentamicin (synergistic dosing).
ADD
IV Flucloxacillin5, 10 2g 6 hourly < 85kg
(4 hrly >85 kg).
If high suspicion of S. aureus endocarditis or PWID.


Penicillin allergy, or MRSA known or suspected
IV Vancomycin3
+ IV Gentamicin (synergistic dosing).

Notes:

Prosthetic Heart Valve

Therapy

IV Vancomycin3
+ IV Gentamicin (synergistic dosing)
+ Oral / IV Rifampicin 300mg - 600mg 12 hourly

Notes:

Notes

Always take blood cultures prior to starting antibiotic treatment. 

Obtain three sets over 24 hours, minimum 30 mins apart, with 10ml in each bottle.

Seek senior specialist advice.

Doses may need to be adjusted in renal impairment. Always check the BNF for interactions. Seek advice if patient pregnant.

Drug Specific Cautions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid / Caution in pregnancy or breastfeeding. Consult BNF for details.
  3. Gentamicin/Vancomycin refer to online calculators.
  4. ALERT Antibiotic - Consult Second line Policy on NHS Lanarkshire Guideline App.
  5. Monitor sodium.
  6. See CURB65 definition.
  7. Reference: The Renal Drug Handbook. Online access.
  8. See Fluoroquinolones MHRA guidance on NHS Lanarkshire Guidelines App.
  9. Doxycycline and quinolones decreased absorption with iron, calcium, magnesium and some nutritional supplements. See BNF appendix 1 or pharmacy for advice.
  10. Caution in renal impairment – see BNF or pharmacy for advice.
  11. Use with caution may increase K+ and decrease renal function. Monitor.
  12. High / Excellent oral bioavailability, IV route available for NBM or vomiting.
  13. See Co-trimoxazole information for prescribers’ safety sheet on NHS Lanarkshire Guidelines App.

Editorial Information

Last reviewed: 01/12/2022

Next review date: 01/12/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: NHS Lanarkshire Antimicrobial Management Committee

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: March 2023