Template:Endocarditis Empiric Antibiotics

Native Valves

Options:

• Ampicillin/Sulbactam 12g/day IV in 4 doses + Gentamicin 3mg/kg/day IV in 2 or 3 doses
• Amoxicillin/Clavulanate 12g/day in 4 dose + Gentamicin 3mg/kg/day IV in 2 or 3 doses
• Oxacillin or Nafcillin 2g IV six times daily + Gentamicin 1mg/kg IV three times daily AND Ampicillin 2g IV six times daily
• Daptomycin 6mg/kg IV once daily

Suspected MRSA:

• Vancomycin 30mg/kg/day IV in 2 doses PLUS
• Gentamicin 3mg/kg/day IV in 2 or 3 doses PLUS
• Ciprofloxacin 1000mg/day PO in 2 doses or 800 mg/day IV in 2 doses

Prosthetic Valves (Early)

Early prosthetic valve endocarditis defined as < 12 months post surgery

• Vancomycin 30mg/kg/day IV in 2 doses PLUS
• Gentamicin 3mg/kg/day IV in 2 or 3 doses PLUS
• Rifampin 1200 mg/day PO in 2 doses

IV Drug User without Prosthetic Valve

• Vancomycin 15-20 mg/kg IV BID daily
• Daptomycin 6mg/kg IV once daily

Prosthetic Valve (Late)

Late prosthetic valve endocarditis defined as ≥ 12 months post surgery

• Same as native valve endocarditis empiric therapy

Dental Procedure Prophylaxis

All antibiotics options are given as a single dose 1 hour prior to the dental procedure

Options:

• Amoxicillin 2g or 50mg/kg
• Ampicillin 2g (50mg/kg) IV or IM
• Cefazolin or Ceftriaxone 1g (50mg/kg) IM or IV
• Clindamycin 600mg (20mg/kg) PO or IV
• Azithromycin or Clarithromycin 500mg (15mg/kg) PO

Miscellaneous

• No therapeutic anticoagulation necessary
  • Anticoagulation carries higher risk of bleeding without reducing embolic complication or mortality benefit
• [Septic pulmonary embolism]
  • Most common culture growths were MSSA, MRSA, and candida
  • Furthermore, therapeutic anticoagulation not indicated for [septic pulmonary embolism]