Standard regimen for prosthetic valve endocarditis
For adults and children with prosthetic valve endocarditis caused by viridans streptococci or S. bovis group with penicillin MIC 0.125 mg/L or lower, use:
benzylpenicillin 1.8 g (child: 50 mg/kg up to 1.8 g) intravenously, 4-hourly for 6 weeks. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment. benzylpenicillin benzylpenicillin benzylpenicillin
Although the addition of gentamicin has not been shown to improve cure rates, the evidence is limited. For complicated cases (ie those with large vegetation [eg 10 mm or greater in adults], perivalvular abscess, multiple emboli, secondary septic events), consider adding:
gentamicin (adult and child) 1 mg/kg intravenously, 8-hourly for 2 weeks (monitor plasma concentration; see Principles of aminoglycoside use)1. gentamicin gentamicin gentamicin