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Suggested regimens for therapy of native or prosthetic valve endocarditis due to HACEK* microorganisms

Suggested regimens for therapy of native or prosthetic valve endocarditis due to HACEK* microorganisms
American Heart Association (AHA) European Society of Cardiology (ESC)
Adult Pediatric Adult

One of the following:

Ceftriaxone 2 g per 24 hours IV in one dose for 4 weeksΔ

or

Ampicillin◊ 2 g IV every 4 hours for 4 weeksΔ

or

Ciprofloxacin§ 1000 mg per 24 hours orally in two divided doses or 800 mg per 24 hours IV in two divided doses for 4 weeksΔ

Monotherapy:

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 4 weeksΔ

or

Cefotaxime 200 mg/kg per 24 hours IV in four divided doses (maximum dose: 12 g per 24 hours) for 4 weeksΔ		 One of the following:

Ceftriaxone 2 g per 24 hours IV in one dose for 4 weeksΔ

or

Combination therapy with: Ampicillin◊ 12 g per 24 hours IV in six divided doses plus Gentamicin¥ 3 mg/kg per 24 hours IV or IM in two or three divided doses for 4 to 6 weeksΔ

or

Ciprofloxacin§ 750 mg every 12 hours orally or 400 mg every 8 or 12 hours IV for 4 weeksΔ

Combination therapy:

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 4 weeksΔ

plus

Gentamicin¥ 3 to 6 mg/kg per 24 hours IV in three divided doses for 4 weeksΔ
The doses in this table are intended for patients with normal renal function. The doses of many of these agents must be adjusted in the setting of renal insufficiency; refer to the Lexicomp drug-specific monographs for renal dose adjustments.
Wherever intramuscular administration is provided as an alternative, intravenous route is preferred, particularly in infants and children.
IV: intravenously; NVE: native valve endocarditis; PVE: prosthetic valve endocarditis.
* Haemophilus parainfluenzae, Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus), Aggregatibacter actinomycetemcomitans (formerly Actinobacillus actinomycetemcomitans), Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae.
¶ Ceftriaxone is preferred. Cefotaxime or another third- or fourth-generation cephalosporin may be substituted. Patients who do not tolerate ceftriaxone should be treated in consultation with an infectious diseases specialist.
Δ The AHA and ESC favor 4 weeks of therapy for NVE and 6 weeks of therapy for PVE.
◊ If growth in vitro is adequate to obtain definitive susceptibility testing results and susceptibility to ampicillin has been demonstrated (ie, non-beta-lactamase-producing organism).
§ Fluoroquinolone therapy recommended only for patients unable to tolerate cephalosporin or ampicillin therapy; levofloxacin or moxifloxacin may be substituted. Fluoroquinolone therapy is not generally recommended for patients <18 years. Treatment for 6 weeks is reasonable for patients with PVE.
¥ 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 3 to 4 mcg/mL, trough <1 mcg/mL when two to three divided doses used.
Data from:
  1. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications: A scientific statement for healthcare professionals from the American Heart Association. Circulation 2015; 132:1435.
  2. Baltimore RS, Gewitz M, Baddour LM, et al. Infective Endocarditis in Childhood: 2015 Update: A Scientific Statement From the American Heart Association. Circulation 2015; 132:1487.
  3. Authors/Task Force Members, Habib G, Lancellotti P, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075.
  4. Gould FK, Denning DW, Elliott TS, et al. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2012; 67:269.
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