NHSAAA Medicines - - Infective endocarditis in native valves

Infection

Infective endocarditis in native heart valves - sub-acute presentation, not IVDU

Antibiotic Therapy (before prescribing, carefully read the Notes / Comments section below)

Amoxicillin IV 2g 4 hourly

and

Gentamicin* IV (synergistic dosing)

If true penicillin / beta-lactam allergy:

Vancomycin IV (dosing info here)

and

Gentamicin* IV (synergistic dosing)

Notes / Comments

Gentamicin must not be administered to patients with myasthenia gravis as it can precipitate a myasthenic crisis.

*Synergistic gentamicin dosing:

For guidance on dose, monitoring and duration see Synergistic Dosing of Gentamicin guideline.
Prescribe synergistic gentamicin on HEPMA - do not prescribe synergistic gentamicin on a gentamicin prescribing, administration and monitoring chart.
Use the specific synergistic gentamicin monitoring chart for monitoring levels.

Guideline reviewed	October 2023
Page updated	February 2024