Native Valve Highly Susceptible to PCN MIC ≤ 0.12μg/mL

Viradans Gr Strept & S. bovis

4wk OR 2wk (uncomplicated) w/ gent 2wk

PCN G 12-18million U/Q24H IV continuously or 4-6 DD X 4 wks OR Ceftriaxone 2g IV X 1dose x 4 wks

PCN G 12-18 million U/Q24H IV continuously or 6 DD x 2 wks OR Ceftriaxone 2g IV X 1 dose x 2 wks

PLUS Gent 3mg/kg X 1 dose X 2 wks

Native valve Relatively resistant PCN MIC >0.12 ug/mL ≤0.5 ug/mL Viridans Gr Strept & S. bovis

4wk + 2wk Gent

PCN G 24 million U/Q24H continuously or 4-6 DD X 4 wks

OR Ceftriaxone 2g IV X 1 dose X 4 wks

PLUS Gentamicin 3mg/kg IV Q24H X 1 dose X 2wks

 Vancomycin 30mg/kg / Q24H IV x 2DD X 4wks

Prosthetic valve Staphylococcus Oxacillin susceptible 

same as above Oxacillin resistant

both 3 drug ≥ 6 wks

Nafcillin or Oxacillin 12g IV x 6 DD ≥ 6 wks PLUS Rifampin 900mg IV x 3 DD ≥ 6 wks PLUS Gentamicin IV x 2-3 DD X 2 wks

Vancomycin 30mg/kg  IV x 2 DD ≥ 6 wks PLUS rifampin 900mg IV x 3 DD ≥ 6 wks PLUS Gentamicin 3mg/kg IV  x 2-3 DD x 2 wks

Prosthetic or Native valve PCN susceptible MIC ≤0.12ug/mL Viridans Gr Strept & S. bovis 

6 wk & 2 wk Gent

(same as above but)

PCN susceptible MIC >0.12ug/mL  

6 wk all

PCN G 24 million IV Q24H continuously OR      4-6 DD X 6 wks OR Ceftriaxone 2g X 1 dose X 6 wks

w or w/o Gent 3mg/kg x 1 dose X 2wks OR 

Vancomycin 30mg/kg X 2 DD X 6wks

PCN G 24 million IV Q24H continuously OR    4-6 DD X 6 wks  OR Ceftriaxone 2g IV X 1 dose X 6 wks

PLUS

Gentamicin 3mg/kg x 1 dose X 6 wks  OR Vanc same as above

Native Staphylococcus Oxacillin susceptible 

6wk + 3-5 days Gent

same as above

Oxacillin resistant

Oxacillin susceptible

Naficillin or oxacilllin 12g IV 4-6 DD x 6 wks w/ Gent 3mg/kg X 2-3 DD x 3-5days IF PCN ALL. Cefazoline 6g x 2-3 DD X 6 wks w/ Gent 3mg/kg X 2-3 DD X 3-5 days

oxacilllin resistant

Vancomycin 30mg/kg IV X 2 DD X 6 wks