CAR 2.3 Endocarditis - Enterococci

Recommendations

≥ 18 years

Indications: Amoxicillin susceptible
	Dosage	Remarks
	amoxicillin iv 12 g/24 h in divided doses for 6 weeks + ceftriaxone iv 2000 mg twice daily for 6 weeks	Native valve or prosthetic valve

≥ 18 years

Indications: Amoxicillin resistant
	Dosage	Remarks
	vancomycin iv for 6 weeks + gentamicin iv 3 mg/kg once daily for 6 weeks	Native valve or prosthetic valve For vancomycin dosing see vancomycin \| Radboud UMC

≥ 18 years

Indications: penicillins contraindicated*
	Dosage	Remarks
	vancomycin iv for 6 weeks + gentamicin iv 3 mg/kg once daily for 6 weeks	For vancomycin dosing see vancomycin

General advice

Obtain two blood cultures every 48 hours after starting treatment until the cultures are negative. For determining the duration of treatment, day 1 is the day on which the blood cultures are first negative.
The duration of treatment after surgery is determined by the result of the valve culture. In the case of a positive culture a full course of treatment is given after surgery. If the culture is negative, the duration of therapy after surgery is the prescribed duration minus the duration of treatment prior to surgery.
Consult the infectious diseases specialist for advice regarding additional investigations and management of therapy.