Native valve

- 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
Viridans Group Streptococci

 
Rare:

Enterococcus spp
HACEK organisms

 

Empiric Therapy Dose Duration
Vancomycin 60mg/kg/d IV div q6h See Treatment of Culture-proven Endocarditis in Recommended Therapy of Culture-Directed Infections in Adult Patients. Use pediatric doses (Table A).
+    
Ceftriaxone 100mg/kg IV daily  

Severe penicillin/cephalosporin allergy

Empiric Therapy Dose Duration
Vancomycin 60mg/kg/d IV div q6h See Treatment of Culture-proven Endocarditis in Recommended Therapy of Culture-Directed Infections in Adult Patients. Use pediatric doses (Table A).
+    
Gentamicin 3mg/kg/d IV div q8h