Native Valve Endocarditis - Indolent presentation

First Line

Amoxicillin 2g IV 4hrly AND gentamicin 1mg/kg IV bd (synergistic dose)

OMIT synergistic gentamicin if patient has acute kidney injury

Penicillin Allergy

Vancomycin IV as per protocol AND gentamicin IV as per protocol (treatment dose)

If true vancomycin allergy, replace with Daptomycin 6mg/kg IV od (monitor CK)

If acute kidney injury, replace gentamicin with Ciprofloxacin 750mg PO bd or 400mg IV 8hrly

Notes

For synergistic dosing of gentamicin -> aim for peak 3-5mg/l and trough <1mg/l

If renal function is poor or deteriorating, discuss dosing and frequency with pharmacist ASAP