Version May 2024
| American Heart Association (AHA)¶ | European Society of Cardiology (ESC) | |
| Adult dose | Pediatric dose | Adult dose |
| Strains with intrinsic penicillin resistanceΔ | ||
| Vancomycin◊ 30 mg/kg per 24 hours IV in two divided doses for six weeks plus Gentamicin§ 3 mg/kg per 24 hours IV or IM in three divided doses for six weeks | Vancomycin◊ 40 mg/kg per 24 hours IV (maximum dose: 2 g per 24 hours unless levels are inappropriately low) in two or three divided doses for six weeks plus Gentamicin§ 3 to 6 mg/kg per 24 hours IV in three divided doses for six weeks | Vancomycin◊ 30 mg/kg per 24 hours IV in two divided doses for six weeks plus Gentamicin§ 3 mg/kg per 24 hours IV or IM in one dose for six weeks |
| Beta-lactamase-producing strains | ||
| Ampicillin-sulbactam¥ 3 g every 6 hours IV for six weeks or Vancomycin◊ 30 mg/kg per 24 hours IV in two divided doses for six weeks plus Gentamicin§ 3 mg/kg per 24 hours IV or IM in three divided doses for six weeks | Refer to above | Ampicillin-sulbactam¥ 12 g per 24 hours (or 300 mg/kg per 24 hours) IV in four equally divided doses for four to six weeks‡ or Amoxicillin-clavulanate¥ 200 mg/kg (amoxicillin component) per 24 hours IV in six equally divided doses for four to six weeks‡ or Vancomycin◊ 30 mg/kg per 24 hours IV in two divided doses for six weeks plus Gentamicin§ 3 mg/kg per 24 hours IV or IM in one dose for four to six weeks‡ |
IV: intravenously; IM: intramuscularly; MIC: minimum inhibitory concentration; NVE: native valve endocarditis; PVE: prosthetic valve endocarditis; HLAR: high-level aminoglycoside resistance.
* Patients with isolates susceptible to penicillin who are unable to tolerate beta-lactams should receive treatment as for infection due to isolates with intrinsic penicillin resistance.
¶ Duration of treatment for prosthetic valve or other prosthetic material infective endocarditis is a minimum of six weeks.
Δ Intrinsic penicillin resistance defined as penicillin or ampicillin MIC ≥16 mcg/mL; consultation with infectious disease specialist recommended.
◊ Vancomycin therapy is recommended only in the setting of intrinsic penicillin resistance or for patients unable to tolerate beta-lactams (refer to text regarding beta-lactam intolerance). Vancomycin dose should be adjusted for serum trough concentration 10 to 20 mcg/mL; some favor trough concentration 15 to 20 mcg/mL. In adults, vancomycin is dosed based on actual body weight. The dose may need to be increased beyond 30 mg/kg and frequency may need to be increased to three divided doses.
§ Renal function and gentamicin serum concentrations should be monitored at least once per week. In non-obese and non-underweight adults, aminoglycosides are dosed based on ideal body weight. Gentamicin dosage adjusted for peak serum concentrations 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).
¥ If strain is gentamicin resistant, then >6 weeks of ampicillin-sulbactam or amoxicillin-clavulanate therapy may be needed. Refer to local product information for optimal dosing and frequency of intravenous amoxicillin-clavulanate. Strain should be evaluated for HLAR to streptomycin.
‡ 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.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
