Prosthetic valve
- Recommend urgent cardiovascular surgery consult if:
etiology is S. aureus, P. aeruginosa, fungi
heart failure
diabetes and/or renal failure
valve ring abscess.
- Tailor antibiotic therapy to C&S results. β-lactams superior to vancomycin so preferred if susceptible. If penicillin allergy reported, allergy should be confirmed by an allergist and desensitization considered.
Usual Pathogens
S. aureus/MRSA
Coagulase negative Staph
Viridans Group Streptococci
Enterococcus spp
Enterobacterales
Fungi
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin | 60mg/kg/d IV div q6h | See Treatment of Culture-proven Endocarditis in Adult Empiric Therapy Recommendations. Use pediatric doses (Table A). |
| + | ||
| Gentamicin | 3mg/kg/d IV div q8h | |
| + | ||
| Rifampin | 15-20mg/kg/d PO div bid |