UNIVERSITI SAINS MALAYSIA

ANTIMICROBIAL THERAPY FOR INFECTIVE ENDOCARDITIS

STREPTOCOCCI

Valve Antibiotic Dosage & Intervals Duration

Native valve Penicillin G 18-24 million U/24 4 weeks
h IV in 6 equally
divided doses
Or Ceftriaxone 2g IV daily 4 weeks
Plus Gentamicin 1 mg/kg IV 8 2 weeks
hourly

Native valve -  Vancomycin 30 mg/kg/24 h IV 4 weeks

lactam allergic in 2 equally
divided doses, not
to exceed 2g/24h
unless serum
levels are
monitored
Prosthetic valve Penicillin G 18-24 million U/24 6 weeks
(vancomycin for h IV in 6 equally
patients allergic to divided doses
-lactams)
Plus Gentamicin 1 mg/kg IV 8 2 weeks
hourly
STAPHYLOCOCCI

Valve Antibiotic Dosage & Interval Duration

Methicillin-sensitive
Native valve Cloxacillin 2g IV 4 hourly 4-6 weeks
Plus Gentamicin 1 mg/kg IV 8 2 weeks
hourly
Native valve - Vancomycin 30 mg/kg/24 h IV 4-6 weeks
lactam allergic in 2 equally
divided doses, not
to exceed 2g/24h
unless serum
levels are
monitored
Prosthetic valve Cloxacillin 2g IV 4 hourly  6 weeks
Plus Rifampicin 300mg PO 8 hourly  6 weeks
Plus Gentamicin 1mg/kg IV 8 2 weeks
hourly
Methicillin-resistant (MRSA)
Native valve Vancomycin 30 mg/kg/24 h IV 4-6 weeks
in 2 equally
divided doses, not
to exceed 2g/24h
unless serum
levels are
monitored
Plus Gentamicin 1mg/kg IV 8 2 weeks
hourly
Prosthetic valve Vancomycin 30 mg/kg/24 h IV  6 weeks
in 2 equally
divided doses, not
to exceed 2g/24h
unless serum
levels are
monitored
Plus Rifampicin 300mg PO 8 hourly  6 weeks
Plus Gentamicin 1mg/kg IV 8 2 weeks
hourly
For strains resistant to gentamicin or other aminoglycosides, a fluoroquinolone
may be used

Adapted form ACC/AHA Valvular Heart Disease Guidelines:2008 Focused Update

Incorporated

Prepared by:

Dr Mohd Sapawi Mohamed

Dr Suhairi Ibrahim

Reviewed by A. Prof Zurkurnai Yusof