CAR 4.1 CIED infections

Content version: U-275.2
Updated: 10/20/2025 - 15:12

Recommendations

≥ 18 years

Indications: Superficial wound infection at the pocket site/isolated pocket infection, without bacteraemia.
	Dosage	Remarks
1st choice	flucloxacillin oral 500 mg 4 times daily 10 days	mild
1st choice	flucloxacillin IV 6000 mg continuous infusion per 24 hours 10 days or flucloxacillin IV 1000 mg 6 times daily 10 days	severe for continuous infusion: loading dose 1000 mg once.
2nd choice	clindamycin oral 600 mg 3 times daily 10 days	penicillins contraindicated* mild
2nd choice	cefazolin IV 2000 mg 3 times daily 10 days	penicillins contraindicated* severe

≥ 18 years

Indications: proven CIED lead infection
	Dosage	Remarks
		Treat as prosthetic valve endocarditis: Heart and thorax \| Radboud UMC -Indication for removal of the CIED, discuss with the electrophysiologist and also discuss in the endocarditis team. -See also the CIED infection on Q-portal

Comments

*see protocol Policy for allergy to antibiotics | Radboud UMC

If started on IV antibiotics and clinical improvement occurs, an IV-to-oral switch may be considered.

For isolated pocket infection, removal of the CIED is indicated; see the CIED infection protocol on Q-portal: CIED infection