Prosthetic valve
- For surgical indications (heart failure, uncontrolled infection, prevention of embolic events) and timing see Circulation 2015; 132:1435-86, or European Heart J 2015; 36:3075-128, Table 22.
- 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
Enterococcus spp
Viridans Group Strep including S. gallolyticus (S. bovis biotype I)
Enterobacterales
P. aeruginosa
Coryneform bacteria (e.g. Corynebacterium spp, Actinomyces spp, Propionibacterium spp)
Rare:
Legionella spp
Fungi
Mycobacterium spp
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin | 15mg/kg IV q8-12h | 6 weeks |
| + | ||
| Gentamicin | 3mg/kg IV daily | 2 weeks |
| + | ||
| Rifampin | 300mg PO tid or | 6 weeks |
| 600mg PO bid |