Table 3 Antibiotic treatment for staphylococcal infective endocarditis (IE).
| No allergy to penicillin | Allergy to penicillin | Duration | |||
|---|---|---|---|---|---|
| Drug | Dosage | Drug | Dosage | ||
| Native valve IE | |||||
| Oxa‐S strain | Oxacillin† | 150–200 mg/kg/d | Vancomycin§ | 30 mg/kg/d | 4–6 weeks (5 days combination) |
| + gentamicin‡ | 3 mg/kg/d | or cefamandole** | 75–100 mg/kg/d | ||
| + gentamicin‡ | 3 mg/kg/d | ||||
| Oxa‐R strain | Vancomycin§ | 30 mg/kg/d | Vancomycin§ | 30 mg/kg/d | 4–6 weeks (5 days combination) |
| ± gentamicin‡ | 3 mg/kg/d | ± gentamicin‡ | 3 mg/kg/d | ||
| Prosthetic valve IE* | |||||
| Oxa‐S strain | Oxacillin† | 150–200 mg/kg/d | Vancomycin§ | 30 mg/kg/d | ⩾6 weeks combination (aminoglycoside no longer than 15 days) |
| + gentamicin‡ | 3 mg/kg/d | + gentamicin‡ | 3 mg/kg/d | ||
| + rifampicin | 20–30 mg/kg/d | + rifampicin | 20–30 mg/kg/d | ||
| Oxa‐R, genta‐S strain | Vancomycin§ | 30 mg/kg/d | Vancomycin§ | 30 mg/kg/d | ⩾6 weeks combination (aminoglycoside no longer than 15 days) |
| + rifampicin | 20–30 mg/kg/d | + rifampicin | 20–30 mg/kg/d | ||
| + gentamicin‡ | 3 mg/kg/d | + gentamicin‡ | 3 mg/kg/d | ||
| Oxa‐R, genta‐R strain | Vancomycin§ | 30 mg/kg/d | Vancomycin§ | 30 mg/kg/d | ⩾6 weeks combination |
| + rifampicin¶ | 20–30 mg/kg/d | + rifampicin¶ | 20–30 mg/kg/d | ||
| + other antistaphylococccal drug, if available | + other antistaphylococccal drug, if available | ||||
*Valve replacement should be considered, inasmuch as IE develops early after valve implantation.
†Other choices: cloxacillin 100–150 mg/kg/d; cefamandole 75–100 mg/kg/d.
‡Other choice: netilmicin (5–6 mg/kg/d).
§Other choice: teicoplanin, target serum trough concentrations 25–30 mg/l.
¶If strain resistant to rifampicin, combine vancomycin with one or two other antistaphylococcal drugs, according to susceptibility pattern.
**The use of a cephalosporin is not recommended in patients with a history of anaphylactic reaction to penicillin.
oxa, oxacillin; R, resistant; S, susceptible.