Native valve (non-Injection Drug Users)

- Tailor antibiotic therapy to C&S results. β-lactams superior to vancomycin so preferred if susceptible. If penicillin allergy reported, allergy should be confirmed by an allergist and desensitization considered.

 
Usual Pathogens

S. aureus/MRSA
Viridans Group Streptococci
Enterococcus spp
HACEK organisms
Coagulase negative Staphylococci
Streptococcus gallolyticus (S. bovis biotype 1)
Abiotrophia spp
Granulicatella spp
Gemella spp

 
Rare:

S. pneumoniae
S. pyogenes (Group A)
S. agalactiae (Group B)
ß-haemolytic Streptococci group C&G
Enterobacterales
Neisseria spp
Moraxella spp

 

Empiric Therapy Dose Duration
Vancomycin 15mg/kg IV q8-12h Culture negative - see Blood Culture-Negative Endocarditis.
Culture positive - see Recommended Therapy of Culture-Directed Infections.
+    
Ceftriaxone 2g IV daily  

Severe penicillin/cephalosporin allergy

Empiric Therapy Dose Duration
Vancomycin 15mg/kg IV q8-12h Culture negative - see Blood Culture-Negative Endocarditis.
Culture positive - see Recommneded Therapy of Culture-Directed Infections.
+    
Gentamicin 1mg/kg IV q8h