Version May 2024
| American Heart Association (AHA) | European Society of Cardiology (ESC) | |
| Adult dose | Pediatric dose¶ | Adult doseΔ |
| Aminoglycoside combination regimen◊ | Aminoglycoside combination regimen | |
| Aqueous penicillin G 18 to 30 million units per 24 hours IV continuously or in six divided doses for four to six weeks§ or Ampicillin 2 g IV every 4 hours for four to six weeks§ plus Gentamicin¥ 3 mg/kg per 24 hours IV or IM in three divided doses for four to six weeks§ | Aqueous penicillin G 200,000 to 300,000 units/kg per 24 hours IV in six divided doses (maximum dose: 24 million units per 24 hours) for four to six weeks§ or Ampicillin 200 to 300 mg/kg per 24 hours IV divided in four or six divided doses (maximum dose: 12 g per 24 hours) for four to six weeks§ plus Gentamicin¥ 3 to 6 mg/kg per 24 hours IV in two or three divided doses for four to six weeks§ | Amoxicillin 200 mg/kg per 24 hours IV in four or six divided doses for four to six weeks or Ampicillin 12 g per 24 hours (200 mg/kg per 24 hours) IV in four or six divided doses for four to six weeks plus Gentamicin¥ 3 mg/kg per 24 hours IV or IM in one dose for four to six weeks |
| Beta-lactam combination regimen‡† | 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 (dosing as above) for six weeks | Ceftriaxone 2 g IV every 12 hours for six weeks plus Ampicillin (dosing as above) 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.
¶ Consultation with an infectious disease specialist is recommended for pediatric patients with enterococcal endocarditis.
Δ Pediatric doses (should not exceed adult doses): amoxicillin 200 mg/kg per 24 hours IV in four to six divided doses; ampicillin 300 mg/kg per 24 hours IV in four or six divided doses; ceftriaxone 100 mg/kg per 24 hours IV or IM in two divided doses; gentamicin 3 mg/kg per 24 hours IV or IM in three divided doses; vancomycin 40 mg/kg per 24 hours IV in two or three divided doses.
◊ Recommended for patients with baseline creatinine clearance >50 mL/min.
§ 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. For adult patients with gentamicin-susceptible isolates, some experts shorten gentamicin component to two weeks when used in combination with a beta-lactam, particularly with emergence of nephrotoxicity (refer to text).
¥ Renal function and gentamicin serum concentrations should be monitored at least once per week. In adults, aminoglycosides are dosed based on ideal body weight. Gentamicin dosage adjusted for peak serum concentrations are 3 to 4 mcg/mL, trough <1 mcg/mL when two to three divided doses used. When given in a single daily dose, pre-dose (trough) concentrations should be <1 mcg/mL. Per ESC guidelines, post-dose (peak, one hour after injection) serum concentrations should be approximately 10 to 12 mcg/mL (per AHA guidelines, there is no role for measuring peak gentamicin concentration following single daily dosing).
‡ Recommended for patients with creatinine clearance ≤50 mL/min (either at baseline or while on therapy with aminoglycoside-containing regimen).
† 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 active against Enterococcus faecium. This regimen is reasonable for patients with normal or impaired renal function, abnormal cranial nerve VIII function, or if the laboratory is unable to provide rapid results of aminoglycoside serum concentration.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
