Page 214 - HPP ANTIMICROBIAL GUIDELINE 2018
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Infection/Condition Suggested Treatment Comments
Preferred Alternative
Infective Endocarditis
Streptococcus viridans
Strains fully susceptible to penicillin Benzylpenicillin 200,000-300,000 Ceftriaxone 100mg/kg IV/IM q24h for Maximum dosages per 24
(MIC < 0.125 mg/l) units/kg/24h IV q4-6h for 4 weeks 4 weeks hours: penicillin 12-24 MU;
ampicillin 12gm; ceftriaxone
Strains resistant to penicillin (MIC ≥ Benzylpenicillin 200,000-300,000 PLUS/MINUS 4gm, gentamicin 240 mg.
0.2 mg/l) units/kg/24h IV q4-6h for 4 weeks Gentamicin 1mg/kg IV/IM q8h for 2
weeks Vancomycin dose adjusted for
PLUS trough concentration of 15-20
Gentamicin 1mg/kg IV/IM q8h for 2 Penicillin/Ceftriaxone allergic: mg/ml
weeks Vancomycin 40mg/kg/24h IV q8-12h
for 4 weeks
Enterococcus Ampicillin 300 mg/kg/24h IV q4-6h for Penicillin allergic:
4-6weeks Vancomycin 40 mg/kg/day IV q8-12h
PLUS PLUS
Gentamicin 1mg/kg IV/IM q8h for 4-6 Gentamicin 1mg/kg IV/IM q8h for 2
weeks weeks for 4-6 weeks
Staphylococcus
Methicillin sensitive Cloxacillin 200 mg/kg/24h IV q4-6h Penicillin allergic: Clinical benefit of
for 6 weeks Cefazolin 100 mg/kg/24h IV q8h for 6 aminoglycosides has not been
weeks established.
PLUS
Gentamicin 1mg/kg IV/IM q8h for 3-5 OR Cefazolin or other first-
days Vancomycin 40 mg/kg/24h IV q2-4h generation cephalosporin in
for 6 weeks equivalent dosages may be
(Target trough concentration used in patients who do not
between 15-20 µg/ml) have a history of immediate
Methicillin Resistant Vancomycin 60 mg/kg/24h IV q6h for type hypersensitivity to
6 weeks penicillin or ampicillin.
HPP AMG Cardiovascular Infection 102
