Endocarditis prophylaxis regimens

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Endocarditis

Possible therapeutic alternatives

Prophylaxis (Adults). Dental / oral / respiratory tract or Esophageal procedures:

Standard regimen:

Amoxicillin 2 grams orally 1 hour before procedure.

If unable to take oral medications give:

Ampicillin 2 grams IM or IV 30 minutes before procedure.

If allergic to penicillin:

Clindamycin 600mg orally 1 hour before or [Keflex or Duricef: 2 grams 1 hour before] or [Zithromax or Clarithromycin: 500mg 1 hour before].

If unable to take oral meds and allergic to penicillin:

Clindamycin 600mg IV 30 minutes before procedure or Ancef 1 gram IM or IV 30 minutes before procedure.

Prophylaxis (Adults). Genitourinary/ gastrointestinal procedures:

High risk patients:

Ampicillin 2 grams IM or IV + Gentamycin 1.5 mg/kg (max 120mg) within 30 minutes of procedure, then in 6 hours give Ampicillin 1 gram IM or IV or Amoxicillin 1 gram orally.

High risk patients allergic to penicillin:

Vancomycin 1 gram IV + Gent 1.5 mg/kg IV or IM--complete infusion within 30 minutes of starting procedure.

Moderate risk patients:

Amoxicillin 2 grams orally 1 hour before or ampicillin 2 grams IV or IM 30 minutes before.

Moderate risk + penicillin allergic:

Vancomycin 1 gram IV over 1-2hrs (complete infusion 30 minutes before.)

Native Valve, Subacute:

Common pathogens

Penicillin G 4 million units IV q4h + [Nafcillin or Oxacillin 2 grams IV q4h] + Gentamicin

Ampicillin 2 grams IV q4h + [Nafcillin or Oxacillin 2 grams IV q4h] + Gentamicin

Ampicillin-sulbactam 3g IV q 6h + gent/tobra or

Vancomycin 1 gram IV q12h + Gentamicin

vancomycin 1g q12h + Ceftriaxone 2g IV q12h

Indications for Surgery: CHF, hemodynamic compromise, fungal etiology, unresolving bacteremia, continuing embolization, progressive heart block, valvular ring abscess, relapse.

Prosthetic Valve:

Common pathogens

Methicillin Sensitive Staphylococcus:

Nafcillin or Oxacillin 2 g IV q4h x 6 weeks plus Rifampin 300 mg PO q8h x 6 weeks plus Gentamicin IV or IM q8h x 2 weeks

Methicillin Resistant Staphylococcus:

Vancomycin 1 g IV q12h x 6 weeks + Rifampin 300 mg PO q8h x 6 weeks + Gentamicin IV or IM q8h x 2 weeks.

Streptococcus viridans or Enterococci:

same as for native valve endocarditis.

Pseudomonas aeruginosa:

Tobramycin + [Piperacillin-tazobactam (Zosyn) or Ticarcillin-clavulanic acid (Timentin) or Ceftazidime ]

Antimicrobial Series
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