CAR 2.1 Endocarditis - Staphylococci (S. aureus, S. epidermidis etc)

Recommendations

≥ 18 years
	Dosage	Remarks
	flucloxacillin iv 12 g/24 h 6 weeks	Native valve, flucloxacillin susceptible Loading dose 2 g flucloxacillin bolus, then continuous infusion. (If continuous infusion is not possible, then flucloxacillin 6 times daily 2 g)
	vancomycin iv 6 weeks	Native valve, flucloxacillin resistant For vancomycin dosing see vancomycin \| Radboud UMC
	flucloxacillin iv 12 g/24 h 6 weeks + rifampicin iv 600 mg twice daily 6 weeks + gentamicin iv 3 mg/kg once daily 2 weeks	Prosthetic valve or other prosthetic material in the heart, flucloxacillin susceptible Loading dose 2 g flucloxacillin bolus, then continuous infusion. (If continuous infusion is not possible, then flucloxacillin 6 times daily 2 g)
	vancomycin iv 6 weeks + rifampicin iv 600 mg twice daily 6 weeks + gentamicin iv 3 mg/kg once daily 2 weeks	Prosthetic valve or other prosthetic material in the heart, flucloxacillin resistant For vancomycin dosing see vancomycin \| Radboud UMC

≥ 18 years

Indications: penicillins contraindicated*
	Dosage	Remarks
	cefazolin iv 6 g continuous per 24 h 6 weeks	Native valve, flucloxacillin susceptible (If continuous infusion is not possible, then cefazolin 6 times daily 1 gram)
	cefazolin iv 6 g continuous per 24 h 6 weeks + rifampicin iv 600 mg twice daily 6 weeks + gentamicin iv 3 mg/kg once daily 2 weeks	Prosthetic valve, flucloxacillin susceptible (If continuous infusion is not possible, then cefazolin 6 times daily 1 gram)

≥ 18 years

Indications: cephalosporins contraindicated*
	Dosage	Remarks
	vancomycin iv 6 weeks	Native valve For vancomycin dosing see vancomycin \| Radboud UMC
	vancomycin iv 6 weeks + rifampicin iv 600 mg twice daily at least 6 weeks + gentamicin iv 3 mg/kg once daily 2 weeks	Prosthetic valve For vancomycin dosing see vancomycin \| Radboud UMC

General remarks

After starting treatment, take two blood cultures every 48 hours until cultures are negative. For determining treatment duration, day 1 is the day on which the blood cultures are negative for the first time.
The treatment duration after surgery is determined by the result of the heart valve culture. If the culture is positive, a full course of treatment is given after the operation. If the culture is negative, the therapy duration after the operation is the prescribed treatment duration minus the duration of treatment before the operation.
If a patient with native-valve endocarditis undergoes surgery with implantation of prosthetic material and the valve cultures are negative, the postoperative regimen for native-valve endocarditis is maintained.
Consult the infectious diseases physician for advice regarding additional investigations and management of therapy.
Rifampicin can be administered both orally and intravenously.
Gentamicin level monitoring is desirable around the 3rd dose. See Therapeutic drug monitoring Aminoglycosides v3_0.pdf