Treatment for IE

Question 1

Highly susceptible streptococci in native valve

Answer 1

PCN G (12-18 units/day) OR ceftriaxone 2g/day for 4 wks
OR PCN + Gent for 2 wks or Ceftriaxone + Gent for 2 wks

Question 2

Highly susceptible strept in prosthetic valve

Answer 2

PCN G (24 units/day) OR ceftriaxone 2g/day
and mandatory 2 wk course gentamicin
DoT: 6 wks

Question 3

Relatively resistant Strept in native valve

Answer 3

PCN G (24 units/ 24 hr) OR ceftriaxone 2g/day
+ mandatory 2 wk course gentamicin
DoT: 4 wk

Question 4

Relatively resistant strept in prosthetic valve

Answer 4

PCN G (24 units/24 hr) OR ceftriaxone 2g/24 hr
and mandatory 6 wk course gentamicin
DoT: 6 wk

Question 5

Highly resistant strept in native valve

Answer 5

ampicillin (12g/ 24 hr) OR PCN G (18-30 units/day) + 4-6 wk gentamicin or ceftriaxone
DoT: 4-6 wk

Question 6

Highly resistant strept in prosthetic valve

Answer 6

ampicillin (12g/ 24 hr) OR PCN G (18-30 units/day) + 4-6 wk gentamicin or ceftriaxone
DoT: 6 wk or longer

Question 7

Enterococci susceptible in native or prosthetic

Answer 7

ampicillin (12g/ 24 hr) OR PCN G (18-30 units/day) + 4-6 wk gentamicin or ceftriaxone
DoT: 6 wk or longer

Question 8

Enterococci B-lactam resistant of native or prosthetic valve

Answer 8

Linezolid, quinupristin/dalfoprisitn, daptomycin

Question 9

Methicillin Susceptible Staph (MSSA) native valves

Answer 9

nafcillin (12g/ 24 hr)
alternative: cefazolin
DoT: 6 wk

Question 10

Methicillin Susceptible Staph (MSSA) prosthetic valves

Answer 10

nafcillin + rifampin (900 mg/24 hr) + 2 wk gentamicin

DoT: 6 wk or longer

Question 11

Methicillin resistant Staph (MRSA) native valves

Answer 11

Vancomycin
alternative: daptomycin
DoT: 6 wk

Question 12

Methicillin resistant Staph (MRSA) prosthetic valves

Answer 12

vancomycin + rifampin (900 mg/24hr) + 2 wk gentamicin

DoT: 6 wk or longer