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 doses + Gentamicin 3mg/kg/day IV in 2 or 3 doses
• Oxacillin 2g IV six times daily 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 1g (50mg/kg) IM or IV or Ceftriaxone 1g (50mg/kg) IM or IV
• Clindamycin 600mg (20mg/kg) PO or IV
• Azithromycin 500mg (15mg/kg) PO or Clarithromycin 500mg (15mg/kg) PO

Pediatric Dosing:

• Amoxicillin 50mg/kg PO (max 2g) 1hr before procedure
• Ampicillin 50mg/kg IV/IM (max 2g) 30min before procedure if unable to take PO
• PCN allergy: Clindamycin 20mg/kg PO or IV (max 600mg) OR
• Azithromycin 15mg/kg PO (max 500mg) OR
• Cephalexin 50mg/kg PO (max 2g)