Antibiotics - Cardiology

Endocarditis Native Valve

Infection	Native valve endocarditis - blind treatment
Most likely organisms	Streptococci, Staphylococci, Enterococci
Empiric treatment	Amoxicillin 2g q4h iv plus Flucloxacillin 2g q4h iv plus Gentamicin 1mg/kg q12h iv. Always seek advice from microbiology. MRSA/Coagulase Neg staph suspected: Vancomycin 25mg/kg (max 2g) loading dose then 15mg/kg q12h iv plus Gentamicin 1mg/kg q12h iv.
In penicillin allergy	Vancomycin 25mg/kg (max 2g) loading dose then 15mg/kg q12h iv plus Gentamicin 1mg/kg q12h iv.
Duration	Minimum 4-6 weeks based on microbiology C&S results.
Comments	Take 3 sets of blood cultures before starting antibiotics, then begin treatment immediately. Always consult with microbiology. Modify treatment (consult with micro) when blood cultures available. Target serum drug levels Vancomycin pre-dose level: 15-20mg/L Vancomycin 1 hr post-dose level 30-45mg/L Gentamicin pre-dose: ≤1mg/L Gentamicin 1 hr post dose: 3-5mg/L

Infection	Prosthetic valve endocarditis - blind treatment
Most likely organisms	S. aureus., Coagulase negative staphylococci, Streptococci, Enterococci
Empiric treatment	Vancomycin 25mg/kg (max 2g) loading dose then 15mg/kg q12h iv plus Gentamicin 1mg/kg q12h iv plus Rifampicin 300-600mg q12h po/iv, starting 3-5 days post commencing vancomycin and Gentamicin (once bacteraemia cleared).
In penicillin allergy	As above
Duration	At least 6 weeks.
Comments	Take 3 sets of blood cultures before starting antibiotics, then begin treatment immediately. Always consult with microbiology. Modify treatment (consult with micro) when blood cultures available. Target serum drug levels Vancomycin pre-dose level: 15-20mg/L Vancomycin 1 hr post-dose level 30-45mg/L Gentamicin pre-dose: ≤1mg/L Gentamicin 1 hr post dose: 3-5mg/L