Specific Therapy

The American Heart Association (AHA) has published guidelines for the management of IE, including specific treatment recommendations.5 A summary of these treatments for the most common organisms (streptococci, staphylococci, and enterococci) is provided in Tables 74-3 through 74-6. However, for more detailed information (including dosing, length of treatment, etc.) for these organisms or less common organisms, refer to the complete guidelines.5 These guidelines include primary and alternative regimens, as indicated in the treatment tables under strength of recommendation.


Most isolates are highly susceptible to penicillin; therefore, penicillin G remains the regimen of choice. However, ceftriaxone may be used as an alternative agent if the patient is allergic or resistance is suspected to penicillin. Typically, the length of treatment is 4 weeks and remains the most common regimen. However, a shorter course (i.e., 2 weeks) may be employed for a patient with uncomplicated IE due to highly penicillin-susceptible strains with no extracardiac infection or whose creatinine clearance is greater than 20 mL/min. If the shorter length of therapy is chosen, gentamicin should be added to the previous regimens for the entire course (i.e., 2 weeks). Recommended therapies for highly penicillin-susceptible viridans streptococci are summarized in Table 74-3.

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