Table 3.

Selected Prosthetic Valve Endocarditis Treatment Regimens All doses based on normal renal function

Organism	Drug	Duration	Alternative/Comments
Oxacillin-sensitive Staphylococcus	oxacillin/nafcillin 2g IV q4h PLUS rifampin 300 mg IV/PO q8h PLUS gentamicin 1 mg/kg IV/IM q8ha	≥ 6 weeks ≥6 weeks 2 weeks	For non-anaphylactoid penicillin allergy, substitute cefazolin 2g IV q8h for oxacillin/nafcillin. For anaphylactoid penicillin allergy, substitute vancomycin 15 mg/kg IV q12hb for oxacillin/nafcillin
Oxacillin-resistant Staphylococcus	vancomycin 15 mg/kg IV q12hb PLUS rifampin 300 mg IV/PO q8h PLUS gentamicin 1 mg/kg IV/IM q8ha	≥6 weeks ≥6 weeks 2 weeks
Viridans streptococci/S. bovis with penicillin MIC ≤ 0.12 μg/mL	penicillin G 24 million U IV per 24hc WITH OR WITHOUT gentamicin 3 mg/kg IV/IM q24h OR ceftriaxone 2g IV/IM q24h WITH OR WITHOUT gentamicin 3 mg/kg IV/IM q24h	6 weeks 2 weeks 6 weeks 2 weeks	For penicillin/ceftriaxone allergy, vancomycin 15 mg/kg q12hb for 6 weeks without gentamicin
Viridans streptococci/S. bovis with penicillin MIC > 0.12	penicillin G 24 million U IV per 24hc PLUS gentamicin 3 mg/kg IV/IM q24h OR ceftriaxone 2g IV/IM q24h PLUS gentamicin 3 mg/kg IV/IM q24h	6 weeks 6 weeks 6 weeks 6 weeks	For penicillin/ceftriaxone allergy, vancomycin 15 mg/kg q12hb for 6 weeks without gentamicin
Enterococcus spp.	PVE treatment regimens identical to NVE treatment regimens. See Table 2.	-	-

^atarget gentamicin peak 3–4 micrograms/mL; target trough <1 microgram/mL

^btarget vancomycin peak 30–45 micrograms/mL; target trough 10–15 micrograms/mL

^cpenicillin dosing can be by continuous infusion, or dosed q4-6h in equal divided doses adapted with permission from Baddour LM et al [40]