Version May 2024
| American Heart Association (AHA) | European Society of Cardiology (ESC) | |
| Adult dose | Pediatric dose | Adult dose |
| Aminoglycoside combination regimen¶ | Aminoglycoside combination regimen¶ | |
| Ampicillin 2 g IV every 4 hours for four to six weeksΔ or Aqueous penicillin G 18 to 30 million units per 24 hours continuously or in six divided doses for four to six weeksΔ plus Streptomycin◊ 15 mg/kg per 24 hours IV or IM in two divided doses for four to six weeksΔ | Consultation with a pediatric infectious disease expert is recommended in all cases of enterococcal infective endocarditis | Amoxicillin 200 mg/kg/day in four to six doses for four to six weeksΔ or Ampicillin 12 g per day (200 mg/kg per day) in four or six doses for four to six weeksΔ plus Streptomycin◊ 15 mg/kg per 24 hours IV or IM in two divided doses for four to six weeksΔ |
| Beta-lactam combination regimen§ | ||
| Ceftriaxone 2 g IV every 12 hours for six weeks plus Ampicillin 2 g IV every 4 hours for six weeks | Ceftriaxone 100 mg/kg per 24 hours IV in two divided doses or 80 mg/kg in one daily dose (maximum dose: 4 g per 24 hours; if dose is >2 g per 24 hours, use divided dosing every 12 hours) for six weeks plus Ampicillin 200 to 300 mg/kg per 24 hours IV divided in four to six divided doses (maximum dose: 12 g per 24 hours) for six weeks | Ceftriaxone 2 g IV every 12 hours for six weeks plus Ampicillin 2 g IV every 4 hours for six weeks |
NVE: native valve endocarditis; PVE: prosthetic valve endocarditis; IV: intravenously; IM: intramuscularly; HLAR: high-level aminoglycoside resistance.
* Patients unable to tolerate beta-lactams should receive treatment as for infection due to isolates with intrinsic penicillin resistance. Refer to UpToDate table on treatment regimens for native or prosthetic valve endocarditis due to an enterococcal strain resistant to penicillin and susceptible to vancomycin and aminoglycosides.
¶ For treatment of infection due to isolates that are gentamicin resistant and streptomycin susceptible (growth inhibited by 1000 mcg/mL) in patients with creatinine clearance >50 mL/minute. Although this regimen was used effectively before gentamicin was established as the preferred aminoglycoside, AHA 2015 guidelines discourage its use. This is because of general lack of physician familiarity with streptomycin, supply shortages, lack of readily available laboratory testing for serum concentration monitoring, and cranial nerve VIII toxicity (refer to text).
Δ Patients with NVE and symptoms <3 months may be treated for 4 weeks; patients with PVE or NVE with symptoms ≥3 months should be treated for at least 6 weeks.
◊ In adults, streptomycin is dosed based on ideal body weight. Dose should be adjusted to obtain serum peak concentration of 20 to 35 mcg/mL and a trough concentration of <10 mcg/mL.
§ The beta-lactam combination regimen is active against Enterococcus faecalis strains with and without HLAR and is the combination of choice in patients with HLAR E. faecalis endocarditis; it is not bactericidally synergistic against Enterococcus faecium. This regimen is reasonable for patients with normal renal function (and preferred for patients with impaired renal function), abnormal cranial nerve VIII function, and generally in lieu of combination therapy with streptomycin.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
