UNIVERSITY OF PENNSYLVANIA MEDICAL CENTER GUIDELINES FOR ANTIBIOTIC USE

Bacterial Endocarditis

Recommendations are for empiric therapy.
Directed therapy should be based upon culture and sensitivity results.
Clinical Setting Likely Pathogens Empiric Treatment Options Duration/Comments
Native Valve

S. aureus

viridans streptococci

S. pneumoniae

Enterococcus spp.

vancomycin (see nomogram) + gentamicin (peak concentration 3-4mcg/ml, consult pharmacokinetics)

Duration varies based on pathogen.

See AHA guidelines for pathogen specific treatment recommendations.

For chronic or subacute bacterial endocarditis, antibiotics may be held pending culture results if the patient remains clinically stable.

ID consultation is advised.

Prosthetic Valve

S. aureus

coagulase-negative staphylococci

 

vancomycin (see nomogram) + gentamicin (peak concentration 3-4mcg/ml, consult pharmacokinetics)

Duration varies.

See AHA guidelines for pathogen specific treatment recommendations.

ID consultation is advised.

Updated on 12/02/08 by Leanne Gasink, MD, MSCE

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