S. aureus (left-sided/mitral and/or aortic valve)
- Urgent surgical consult required if:
evidence of abscess on echocardiogram
mobile vegetations > 10mm
valve dysfunction
recurrent emboli or enlarging vegetations
prosthetic valve
persistent bacteremia or fever (≥ 5 days) on appropriate antibiotic therapy.
Cloxacillin sensitive (MSSA) - Native Valve
| Therapy | Dose | Duration |
|---|---|---|
| Cloxacillin | 2g IV q4h | 4-6 weeks |
| or | ||
| Cefazolin | 2g IV q8h | |
| Severe penicillin/cephalosporin allergy | ||
| Vancomycin | 15mg/kg IV q8-12h | 6 weeks |
| Intolerant to vancomycin or vancomycin MIC > 2µg/mL | ||
| Daptomycin | 8-10mg/kg IV daily | 6 weeks |
Cloxacillin sensitive (MSSA) - Prosthetic Valve
| Therapy | ||
|---|---|---|
| Cloxacillin | 2g IV q4h | ≥ 6 weeks |
| + | ||
| Gentamicin | 1mg/kg IV q8-12h | 2 weeks |
| + | ||
| Rifampin | 300mg PO tid or | ≥ 6 weeks |
| 600mg PO bid | ||
| Severe penicillin/cephalosporin allergy | ||
| 15mg/kg IV q8-12h | ≥ 6 weeks | |
| + | ||
| Gentamicin | 1mg/kg IV q8-12h | 2 weeks |
| + | ||
| Rifampin | 300mg PO tid or | ≥ 6 weeks |
| 600mg PO bid |
Cloxacillin resistant (MRSA) - Native Valve
- Consult Infectious Diseases.
- Increased incidence of recurrence.
| Therapy | ||
|---|---|---|
| Vancomycin MIC ≤ 2µg/mL | ||
| 15mg/kg IV q8-12h | 6 weeks | |
| Intolerant to vancomycin or Vancomycin MIC > 2µg/mL | ||
| Daptomycin | 6 weeks |
Cloxacillin resistant (MRSA) - Prosthetic Valve
- Consult Infectious Diseases.
- Increased incidence of recurrence.
| Therapy | ||
|---|---|---|
| 15mg/kg IV q8-12h | ≥ 6 weeks | |
| + | ||
| Gentamicin | 1mg/kg IV q8-12h | 2 weeks |
| + | ||
| Rifampin | 300mg PO tid or | ≥ 6 weeks |
| 600mg PO bid | ||
| Vancomycin MIC > 2µg/mL or Vancomycin intolerant | ||
| Daptomycin | 10mg/kg IV daily | ≥ 6 weeks |
| + | ||
| Gentamicin | 1mg/kg IV q8-12h | 2 weeks |
| + | ||
| Rifampin | 300mg PO tid or | ≥ 6 weeks |
| 600mg PO bid |