Highly penicillin susceptible | | Duration: 4 weeks |
Aqueous crystalline penicillin G sodium | 12–18 million U/24 h IV either continuously or in 4 or 6 equally divided doses |
OR |
Ceftriaxone sodium | 2 g/24 h IV/IM in 1 dose |
OR |
Vancomycin hydrochloride (If unable to tolerate penicillin or ceftriaxone) | 30 mg/kg per 24 h IV in 2 equally divided doses |
Duration: 2 weeks |
Aqueous crystalline penicillin G sodium | 12–18 million U/24 h IV either continuously or in 6 equally divided doses |
OR |
Ceftriaxone sodium | 2 g/24 h IV or IM in 1 dose |
PLUS |
Gentamicin sulfate | 3 mg/kg per 24 h IV or IM in 1 dose |
Relatively penicillin resistant | Duration: 4 weeks |
Aqueous crystalline penicillin G sodium | 24 million U/24 h IV either continuously or in 4–6 equally divided doses |
OR |
Vancomycin hydrochloride (If not able to tolerate penicillin or ceftriaxone) | 30 mg/kg per 24 h IV in 2 equally divided doses |
Duration: 2 weeks |
Gentamicin sulfate | 3 mg/kg per 24 h IV or IM in 1 dose |
Staphylococci |
Oxacillin susceptible | Duration: 6 weeks |
Nafcillin or oxacillin | 12 g/24 h IV in 4–6 equally divided doses |
OR |
Cefazolin (if penicillin allergic) | 6 g/24 h IV in 3 equally divided doses |
Oxacillin resistant | Duration: 6 weeks |
Vancomycin | 30 mg/kg per 24 h IV in 2 equally divided doses (keep trough between 10 and 15 mcg/mL) |
OR |
Daptomycin | ≥8 mg/kg/dose (dose adjustment per infectious disease consultant) |
Enterococcus |
Penicillin susceptible | Duration: 4–6 weeks |
Ampicillin sodium | 2 g IV every 4 h |
OR |
Aqueous penicillin G sodium | 18–30 million U/24 h IV either continuously or in 6 equally divided doses |
PLUS |
Gentamicin sulfate | 3 mg/kg ideal body weight in 2–3 equally divided doses |
Duration: 6 weeks |
Double β-lactam ampicillin | 2 g IV every 4 h |
PLUS |
Ceftriaxone | 2 g IV every 12 h |
Aminoglycoside resistant | Duration: 6 weeks |
Double β-lactam ampicillin | 2 g IV every 4 h |
PLUS |
Ceftriaxone | 2 g IV every 12 h |
Penicillin resistant in patients not able to tolerate β-lactams | Duration: 6 weeks |
Vancomycin | 30 mg/kg per 24 h IV in 2 equally divided doses |
PLUS |
Gentamicin | 3 mg/kg per 24 h IV or IM in 3 equally divided doses |
Resistant to penicillin, aminoglycoside, and vancomycin | Duration: >6 weeks |
Linezolid | 600 mg IV or orally every 12 h |
OR |
Daptomycin | 10–12 mg/kg per dose |
HACEK Organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) |
| Duration: 4 weeks |
Ceftriaxone sodium | 2 g/24 h IV or IM in 1 dose |
OR |
Ampicillin sodium | 2 g IV every 4 h |
OR |
Ciprofloxacin | 1000 mg/24 h orally or 800 mg/24 h IV in 2 equally divided doses |
Prosthetic Valve/Material Endocarditis1 |
Drug | Dose |
S. viridans and S. gallolyticus (bovis) |
Penicillin susceptible | Duration 6 weeks |
Aqueous crystalline penicillin G sodium | 24 million U/24 h IV either continuously or in 4–6 equally divided doses |
OR |
Ceftriaxone sodium | 2 g/24 h IV or IM in 1 dose |
| Plus or minus 2 weeks duration of: |
Gentamicin sulfate | 3 mg/kg per 24 h IV or IM in 1 dose |
OR |
Vancomycin hydrochloride (if not able to tolerate penicillin or ceftriaxone) | 30 mg/kg per 24 h IV in 2 equally divided doses |
Relatively or fully penicillin resistant | Duration: 6 weeks |
Aqueous crystalline penicillin G sodium | 24 million U/24 h IV either continuously or in 4–6 equally divided doses |
OR |
Ceftriaxone sodium | 2 g/24 h IV or IM in 1 dose |
PLUS |
Gentamicin sulfate | 3 mg/kg per 24 h IV or IM in 1 dose |
OR |
Vancomycin hydrochloride (if not able to tolerate penicillin or ceftriaxone) | 30 mg/kg per 24 h IV in 2 equally divided doses |
Staphylococci |
Oxacillin susceptible | Duration: ≥6 weeks |
Nafcillin or oxacillin | 12 g/24 h IV in 6 equally divided doses |
PLUS |
Rifampin | 900 mg per 24 h IV or orally in 3 equally divided doses |
PLUS |
Gentamicin (for 2 weeks) | 3 mg/kg per 24 h IV or IM in 2 or 3 equally divided doses |
Oxacillin resistant | Duration: ≥6 weeks |
Vancomycin | 30 mg/kg 24 h in 2 equally divided doses (keep trough between 10 and 15 mcg/mL) |
PLUS |
Rifampin | 900 mg/24 h IV/PO in 3 equally divided doses |
PLUS |
Gentamicin (for 2 weeks) | 3 mg/kg per 24 h IV/IM in 2 or 3 equally divided doses |
Enterococcus |
Penicillin susceptible | Duration: 4–6 weeks |
Ampicillin sodium | 2 g IV every 4 h |
OR |
Aqueous penicillin G sodium | 18–30 million U/24 h IV either continuously or in 6 equally divided doses |
PLUS |
Gentamicin sulfate | 3 mg/kg ideal body weight in 2–3 equally divided doses |
Duration: 6 weeks |
Ampicillin | 2 g IV every 4 h |
PLUS |
Ceftriaxone | 2 g IV every 12 h |
Penicillin susceptible, gentamicin resistant | Duration: 6 weeks |
Ampicillin | 2 g IV every 4 h |
PLUS |
Ceftriaxone | 2 g IV every 12 h |
Penicillin resistant in patients not able to tolerate β-lactams | Duration: 6 weeks |
Vancomycin | 30 mg/kg per 24 h IV in 2 equally divided doses |
PLUS |
Gentamicin | 3 mg/kg per 24 h IV or IM in 3 equally divided doses |
Penicillin resistant, aminoglycosides and vancomycin | Duration: >6 weeks |
Linezolid | 600 mg IV or orally every 12 h |
OR |
Daptomycin | 10–12 mg/kg per dose |
HACEK Organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) |
| Duration: 4 weeks |
Ceftriaxone sodium | 2 g/24 h IV or IM in 1 dose |
| OR |
Ampicillin sodium | 2 g IV every 4 h |
| OR |
Ciprofloxacin | 1000 mg/24 h orally or 800 mg/24 h IV in 2 equally divided doses |