BNF for Children 2011-2012

246 5.1 Antibacterial drugs BNFC 2011–2012Cardiovascular systemEndocarditis: initial ‘blind’ therapyFlucloxacillin (or benzylpenicillin if symptoms less severe) + gentamicinIf cardiac prostheses present, or if penicillin-allergic, or if meticillin-resistant Staphylococcusaureus suspected, vancomycin + rifampicin + gentamicinEndocarditis caused by staphylococciFlucloxacillinAdd rifampicin for at least 2 weeks in prosthetic valve endocarditis.Suggested duration of treatment at least 4 weeks (at least 6 weeks for prosthetic valve endocarditis)If penicillin-allergic or if meticillin-resistant Staphylococcus aureus, vancomycin + rifampicinSuggested duration of treatment at least 4 weeks (at least 6 weeks for prosthetic valve endocarditis)Native-valve endocarditis caused by fully-sensitive streptococci (e.g. viridans streptococci)BenzylpenicillinSuggested duration of treatment 4 weeksAlternative if a large vegetation, intracardial abscess, or infected emboli are absent, benzylpenicillin+ gentamicinSuggested duration of treatment 2 weeksIf penicillin-allergic, vancomycinSuggested duration of treatment 4 weeks5 InfectionsNative-valve endocarditis caused by less-sensitive streptococciBenzylpenicillin + gentamicinSuggested duration of treatment 4–6 weeks (stop gentamicin after 2 weeks for micro-organisms moderatelysensitive to penicillin)If aminoglycoside cannot be used and if streptococci moderately sensitive to penicillin,benzylpenicillinSuggested duration of treatment 4 weeksIf penicillin-allergic or highly penicillin-resistant, vancomycin 1 + gentamicinSuggested duration of treatment 4–6 weeks (stop gentamicin after 2 weeks for micro-organisms moderatelysensitive to penicillin)Prosthetic valve endocarditis caused by streptococciBenzylpenicillin + gentamicinSuggested duration of treatment at least 6 weeks (stop gentamicin after 2 weeks if micro-organisms fullysensitive to penicillin)If penicillin-allergic or highly penicillin-resistant, vancomycin 1 + gentamicinSuggested duration of treatment at least 6 weeks (stop gentamicin after 2 weeks if micro-organisms fullysensitive to penicillin)Endocarditis caused by enterococci (e.g. Enterococcus faecalis)Amoxicillin 2 + gentamicinIf gentamicin-resistant, substitute gentamicin with streptomycin.Suggested duration of treatment at least 4 weeks (at least 6 weeks for prosthetic valve endocarditis)If penicillin-allergic or penicillin-resistant, vancomycin 1 + gentamicinIf gentamicin-resistant, substitute gentamicin with streptomycin.Suggested duration of treatment at least 4 weeks (at least 6 weeks for prosthetic valve endocarditis)Endocarditis caused by haemophilus, actinobacillus, cardiobacterium, eikenella, and kingellaspecies (‘HACEK’ micro-organisms)Amoxicillin 2 + gentamicinSuggested duration of treatment 4 weeks (6 weeks for prosthetic valve endocarditis); stop gentamicin after2 weeksIf amoxicillin-resistant, ceftriaxone + gentamicinSuggested duration of treatment 4 weeks (6 weeks for prosthetic valve endocarditis); stop gentamicin after2 weeks1. Where vancomycin is suggested teicoplanin may be used2. Where amoxicillin is suggested ampicillin may be used