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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Treatment regimens for native valve endocarditis due to penicillin-susceptible viridans streptococci and Streptococcus gallolyticus (bovis)*

Treatment regimens for native valve endocarditis due to penicillin-susceptible viridans streptococci and Streptococcus gallolyticus (bovis)*
American Heart Association (AHA)

 European Society of Cardiology (ESC)

(MIC ≤0.125 mcg/mL)

British Society for Antimicrobial Chemotherapy (BSAC)

(MIC ≤0.125 mcg/mL)

Adult

(MIC ≤0.12 mcg/mL)

Pediatric

(MIC ≤0.1 mcg/mL)
4-week regimens: 4-week regimens:  4-week regimensΔ: 4- to 6-week regimens:

Aqueous penicillin G 12 to 18 million units per 24 hours IV either continuously or in 4 or 6 divided doses

or (if penicillin is unavailable)

Ampicillin 2 g IV every 4 hours

or

Ceftriaxone 2 g per 24 hours IV or IM in 1 dose

Beta-lactam-intolerant patients:

Vancomycin◊ 30 mg/kg per 24 hours IV in 2 divided doses

Aqueous penicillin G 200,000 to 300,000 units/kg per 24 hours IV in 6 divided doses (maximum dose: 24 million units per 24 hours)

or (if penicillin is unavailable)

Ampicillin 200 to 300 mg/kg per 24 hours IV divided in 4 or 6 divided doses (maximum dose: 12 g per 24 hours)

or

Ceftriaxone 100 mg/kg per 24 hours IV​§ in 2 divided doses or 80 mg/kg in 1 daily dose (maximum dose: 4 g per 24 hours; if dose is >2 g per 24 hours, use divided dosing every 12 hours)

Beta-lactam-intolerant patients:

Vancomycin◊ 40 mg/kg per 24 hours IV in 2 or 3 divided doses (maximum dose: 2 g per 24 hours)

 Aqueous penicillin G 12 to 18 million units per 24 hours IV in 4 or 6 divided doses or continuous infusion

or

Amoxicillin 100 to 200 mg/kg per 24 hours IV in 4 to 6 divided doses

or

Ampicillin 12 g per 24 hours (or 100 to 200 mg/kg per 24 hours) IV in 6 divided doses

or

Ceftriaxone¶¥ 2 g per 24 hours IV or IM in 1 dose

or

Vancomycin◊ 30 mg/kg per 24 hours IV in 2 divided doses

Benzylpenicillin‡ 1.2 g every 4 hours IV

or

Ceftriaxone 2 g per 24 hours IV/IM
2-week regimens†: 2-week regimens†: 2-week regimensΔ†: 2-week regimens†:

Either

Aqueous penicillin G 12 to 18 million units per 24 hours IV either continuously or in 6 divided doses

or

Ceftriaxone 2 g per 24 hours IV or IM in 1 dose

plus

Gentamicin**,¶¶ 3 mg/kg per 24 hours IV or IM in 1 dose (preferred) or in 3 divided doses

Not recommended for children due to lack of data

Either

Aqueous penicillin G 12 to 18 million units per 24 hours IV in 4 to 6 divided doses or continuous infusion

or

Amoxicillin 100 to 200 mg/kg per 24 hours IV in 4 to 6 divided doses

or

Ampicillin 12 g (or 100 to 200 mg/kg) per 24 hours IV in 6 divided doses

or

Ceftriaxone¶¥ 2 g per 24 hours IV or IM in 1 dose

plus

Gentamicin**,ΔΔ 3 mg/kg per 24 hours IV or IM in 1 dose

Either

Benzylpenicillin‡ 1.2 g every 4 hours IV

or

Ceftriaxone 2 g per 24 hours IV or IM

plus

Gentamicin** 1 mg/kg every 12 hours IV
The doses above 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 individual Lexicomp drug monographs for renal dose adjustments.
​Wherever intramuscular administration is provided as an alternative, intravenous route is preferred, particularly in infants and children.
MIC: minimum inhibitory concentration; IV: intravenously; IM: intramuscularly.
* MIC thresholds differ between guidelines. AHA adult guidelines use MIC ≤0.12 mcg/mL; AHA pediatric guidelines use MIC ≤0.1 mcg/mL. ESC and BSAC guidelines use MIC ≤0.125 mcg/mL.
¶ Preferred in most patients >65 years or with impairment of 8th nerve or renal function.
Δ Pediatric doses (should not exceed adult doses): Penicillin G 200,000 units/kg per 24 hours IV in 4 to 6 divided doses; amoxicillin 300 mg/kg per 24 hours IV in 4 to 6 divided doses; ceftriaxone 100mg/kg per dose IV or IM daily; vancomycin 40 mg/kg per 24 hours IV in 2 or 3 divided doses; gentamicin 3 mg/kg per 24 hours IV or IM in a single daily dose or in 3 divided doses.
◊ Vancomycin therapy only recommended for patients allergic to penicillin and cephalosporins; vancomycin dose adjusted for trough concentration of 10 to 15 mcg/mL. Penicillin desensitization can be attempted in stable patients. 
§ In infants and children, intravenous antibiotics are recommended rather than intramuscular agents.
¥ Preferred for outpatient therapy.
‡ Amoxicillin 2 g every 4 to 6 hours IV may be used in place of benzylpenicillin 1.2 to 2.4 g every 4 hours. 
† For noncomplicated infective endocarditis. Not intended for patients with known cardiac or extracardiac abscess or for creatinine clearance <20 mL/min, impaired 8th nerve function, or infection due to Abiotrophia, Granulicatella spp, or Gemella spp.
** Renal function and gentamicin serum concentrations should be monitored at least once per week. Gentamicin dose adjusted for peak serum concentrations 3 to 4 mcg/mL, trough <1 mcg/mL when 2 to 3 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, 1 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).
¶¶ Gentamicin may be given as a single daily dose (3 mg/kg per day; preferred in outpatients) or in 2 to 3 equally divided doses (adjusted to achieve a peak serum level of 3 to 4 mcg/mL; preferred in hospitalized patients when serum concentrations can be followed).
ΔΔ Netilmicin (4 to 5 mg/kg/day IV in 1 dose) is an alternative.
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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