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. 2020 Jan 23;28(1):2–42. doi: 10.5606/tgkdc.dergisi.2020.01954

Table 9. Empirical antimicrobial treatment of infective endocarditis[3,65,137,205,368]*.

      Duration (weeks)   
Type of infective endocarditis  Antimicrobial agent  Dosage and route  Native  Prosthetic valve  Comment 
Native valve and late prosthetic valve (>1 year), community acquired endocarditis, subacute course  Ampicillin-sulbactam +  12 g/day** i.v. in 4-6 doses  4  6  Gentamicin should be avoided in patients with initial high serum level of creatinine 
Gentamicin  3 mg/kg/day i.v. in 1 dose  2  2   
Native valve and late prosthetic valve (>1 year), community acquired endocarditis, acute course  Vancomycin +  30-60 mg/kg/day i.v. in 2-3 doses  4-6  ≥6  Duration of treatment should be 6 and ≥6 weeks for native and prosthetic valve endocarditis, respectively, especially in the case of complicated IE, such as with metastatic foci, etc. 
Ampicillin- sulbactam, or  12 g/day** i.v. in 4-6 doses  4-6  ≥6 
Ceftriaxone  2 gr/day, i.v. in 1 dose  4-6  ≥6 
Native valve and late prosthetic valve (>1 year), healthcare associated endocarditis  Vancomycin +  30-60 mg/kg/day i.v. in 2-3 doses  4  6   
Cefepime  6 gr/day, i.v. in 3 doses  4  6   
Native valve and late prosthetic valve (>1 year) endocarditis, b-lactam allergy  Vancomycin +  30-60 mg/kg/day i.v. in 2-3 doses  4  6  Gentamicin should be avoided in patients with a higher risk of nephrotoxicity 
Gentamicin  3 mg/kg/day i.v. in 1 dose  2  2   
Early prosthetic valve endocarditis (≤1 year)  Vancomycin +  30-60 mg/kg/day i.v. in 2-3 doses    6   
Gentamicin +  3 mg/kg/day i.v. in 1 dose  2     
Cefepime +  6 gr/day, i.v. in 3 doses  6     
Rifampin  900 mg/day, i.v. or orally in 3 doses  6     
Cardiac Implantable Electronic Device (CIED) related lead or valve endocarditis  Vancomycin ±  30-60 mg/kg/day i.v. in 2-3 doses  Antimicrobial therapy should be continued for 2-4 and 4-6 weeks for the lead and valve endocarditis, respectively, after the removal of the device.  Addition of either gentamicin, or cefepime, or meropenem to vancomycin should be considered especially for septic patients with unstable hemodynamic status. 
Gentamicin, or  3 mg/kg/day i.v. in 1 dose       
Cefepime, or  6 gr/day, i.v. in 3 doses       
Meropenem  3 gr/day, i.v. in 3 doses       
* Same regimens could be used for patients with negative blood cultures and serological test results.