Treatment regimens for adults not allergic to the penicillins
| Viridans streptococci and Streptococcus bovis |
|---|
| (A) Fully sensitive to penicillin (MIC ⩽ 0.1 mg/l) |
| Benzylpenicillin 7.2 g daily in six divided doses by intravenous bolus injection for two weeks plus intravenous gentamicin 80 mg twice daily for two weeks1-150 (table 2) |
| (B) Reduced sensitivity to penicillin (MIC > 0.1 mg/l) |
| Benzylpenicillin 7.2 g daily in six divided doses by intravenous bolus injection for four weeks plus intravenous gentamicin 80 mg twice daily for four weeks1-150 |
| Enterococci |
| (A) Gentamicin sensitive or low level resistant (MIC < 100 mg/l) |
| Ampicillin or amoxycillin 12 g daily in six divided doses by intravenous bolus injection for four weeks plus intravenous gentamicin 80 mg twice daily for four weeks1-150 |
| (B) Gentamicin highly resistant (MIC ⩾ 2000 mg/l) |
| Ampicillin or amoxycillin 12 g daily in six divided doses by intravenous bolus injection for a minimum of six weeks. Streptomycin can be given if strain is sensitive |
| Staphylococci |
| (A) Penicillin sensitive |
| Benzylpenicillin 7.2 g daily in six divided doses by intravenous bolus injection for four weeks plus intravenous gentamicin 80–120 mg three times daily for one week1-150 |
| (B) Penicillin resistant, methicillin sensitive |
| Flucloxacillin 12 g daily in six divided doses by intravenous bolus injection for four weeks plus intravenous gentamicin 80–120 mg three times daily for one week1-150 |
| (C) Penicillin and methicillin resistant |
| Vancomycin initially 1 g by intravenous infusion given over at least 100 minutes twice daily. Determine blood concentration and adjust dose to achieve one hour postinfusion concentrations of about 30 mg/l and trough levels of 5–10 mg/l. Give for four weeks plus intravenous gentamicin 80–120 mg three times daily for one week1-150 |
↵1-150 Gentamicin levels must be monitored.