Standard regimen for native valve endocarditis

For adults and children with uncomplicated or complicated native valve endocarditis caused by viridans streptococci or S. bovis group with penicillin MIC 0.125 mg/L or lower, use:

1benzylpenicillin 1.8 g (child: 50 mg/kg up to 1.8 g) intravenously, 4-hourly for 4 weeks. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment benzylpenicillin benzylpenicillin benzylpenicillin

OR

2ceftriaxone 2 g (child 1 month or older: 100 mg/kg up to 4 g) intravenously, daily for 4 weeks. For patients with septic shock or requiring intensive care support, use 1 g (child 1 month or older: 50 mg/kg up to 2 g) intravenously, 12-hourly12. ceftriaxone ceftriaxone ceftriaxone

Alternatively, for adults with uncomplicated native valve endocarditis, use:

benzylpenicillin 1.8 g intravenously, 4-hourly for 2 weeks. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment benzylpenicillin benzylpenicillin benzylpenicillin

PLUS

gentamicin 1 mg/kg intravenously, 8-hourly for 2 weeks (monitor plasma concentration; see Principles of aminoglycoside use)3. gentamicin gentamicin gentamicin

1 Pharmacokinetics may be altered in patients who are critically ill (eg because of enhanced kidney clearance or changes in volume of distribution). To ensure adequate drug exposure in patients with streptococcal endocarditis who have septic shock or require intensive care support, a modified dosage of ceftriaxone is recommended. Once the critical illness has resolved, consider switching to the standard dosage. If the isolate is not reported to have dose-dependent susceptibility to ceftriaxone (ie susceptible dose dependent [SDD] or susceptible increased exposure [I or SIE]), it may also be appropriate to switch to the standard dose – seek expert advice.Return
2 Few data are available to guide ceftriaxone dosing recommendations for children with streptococcal endocarditis. The current dosing recommendations are based on the consensus advice of the Antibiotic Expert Group.Return
3 For adults with obesity (body mass index 30 kg/m2 or more), use lean body weight to calculate the dose. For children with obesity, use adjusted body weight to calculate the dose.Return