. 2019 Nov 8;22(4):515–549. doi: 10.1093/europace/euz246

Table 9.

International consensus recommendations for antibiotic therapy including long-term suppressive therapy

Consensus statement		Scientific evidence coding	References
Superficial incisional infection
Empirical treatment: Oral antibiotic treatment covering S. aureus Flucloxacillin oral (amoxicillin-clavulanate is an alternative) If high MRSA prevalence: Trimethoprim-sulfamethoxazole, Clindamycin, Doxycyclin, Linezolid To be adjusted after culture result Duration: 7–10 days	Flucloxacillin p.o. 1 g every 6–8 h (amoxicillin-clavulanate standard dose)	O, R	¹⁹ ^, ⁶⁵
Isolated pocket infection (negative blood cultures)
Empirical treatment: Directed at methicillin-resistant coagulase-negative staphylococci (CoNS) and S. aureus: Vancomycin (Daptomycin is an alternative) If systemic symptoms: For additional Gram-negative coverage, combine with 3rd generation Cephalosporin (or a broader betalactam antibiotic) or Gentamicin To be adjusted after culture result If sensitive staphylococcus: Flucloxacillin (1st generation cephalosporin as an alternative) Partial oral treatment often used Duration post-extraction: 10–14 days	Vancomycin: 30–60 mg/kg/d i.v. in 2–3 doses (Daptomycin 8–10 mg/kg i.v. od) +/- Cephalosporin: standard dose Gentamicin 5–7 mg/kg i.v od** Flucloxacillin: 8 g/d i.v. in 4 doses or (1st generation cephalosporin standard dose)	O, R	¹⁹ ^, ⁵⁹ ^, ⁶⁵
Systemic infections
*Without vegetation on leads or valves ± pocket infection*
Empirical treatment: (directed at methicillin-resistant staphylococci and Gram-negative bacteria): Vancomycin (Daptomycin is an alternative) + 3rd generation Cephalosporin (or a broader betalactam antibiotic) or Gentamicin To be adjusted after culture result If sensitive staphylococcus: Flucloxacillin i.v. (1st generation cephalosporin i.v. as an alternative) Duration post-extraction: 4 weeks (2 weeks if negative blood culture, see text)	Vancomycin: 30–60 mg/kg/d i.v. in 2–3 doses (Daptomycin 8–10 mg/kg od) + Cephalosporin: standard dose i.v or Gentamicin 5–7 mg/kg i.v. od^b Flucloxacillin i.v. dosages as above. (1st generation cephalosporin standard dose i.v.)	O, R	¹⁹ ^, ⁵⁹ ^, ⁶⁵ ^, ⁸¹
*CIED endocarditis with vegetation on leads and/or valves ± embolism*
Empirical treatment: Vancomycin (Daptomycin is an alternative) + 3rd generation Cephalosporin (or a broader betalactam antibiotic) or Gentamicin Adjust to culture result according to ESC endocarditis guidelines 2015 If prosthetic valve and staphylococcal infection: Rifampicin to be added after 5–7 days Duration for native valve infective endocarditis: 4 weeks post extraction, for prosthetic valve endocarditis: (4-) 6 weeks, for isolated lead vegetation: 2 weeks therapy after extraction may be sufficient (in total 4 weeks) except for S. aureus infection, see text	Vancomycin; 30–60 mg/kg/d i.v. in 2–3 doses (Daptomycin 8–10 mg/kg od) + Cephalosporin; standard dose or Gentamicin 5–7 mg/kg i.v. od^b Rifampicin: 900–1200 mg/day orally (or i.v.) in 2 doses	O, R	⁵⁹
*Bacteraemia in a CIED patient without signs of pocket infection or echocardiographic evidence of lead or valve involvement*
According to pathogen specific treatment guidelines, see text		O, R	¹¹⁹ ^, ¹²⁰
Attempted salvage therapy and long-term suppressive therapy
I.v. antibiotics as in prosthetic valve endocarditis for 4–6 weeks Stop antibiotic therapy under close follow-up or continue individualized long-term suppressive oral therapy, see text		E	¹⁰³ ^, ¹¹⁸

Treatment regimens differ between countries depending on prevalence of MRSA and other circumstances—see text. Dosage recommendation needs to be adjusted for kidney function.

For patients with normal renal function.

d, day; E, expert opinion; H, hour; i.v., intravenous; M, meta-analysis; MRSA, methicillin-resistant Staphylococcus aureus; O, observational studies; od, once daily; p.o., per oral; R, randomized trials.