THE CONTEXT
The supplied treatment material relates antimicrobial selection to organism susceptibility and valve type, and provides explicit instructions for alternatives and drug-level monitoring.
Clearly stated antimicrobial associations
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For streptococci with penicillin minimum inhibitory concentration ≤0.125 mg/L, the listed treatment is intravenous benzylpenicillin 1.2 g six times daily.
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For methicillin-sensitive staphylococcal native valve infection, the listed treatment is intravenous flucloxacillin 2 g four to six times daily.
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For methicillin-sensitive staphylococcal prosthetic valve infection, the listed agents are intravenous flucloxacillin and gentamicin plus oral rifampicin, with six-week durations.
Short-course treatment and penicillin allergy
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When the specified short-course eligibility conditions are met, two weeks of benzylpenicillin and gentamicin 1 mg/kg twice daily may be sufficient.
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For non-severe penicillin allergy, ceftriaxone 2 g once daily intravenously or intramuscularly can replace benzylpenicillin.
Therapeutic drug monitoring
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The pre-dose gentamicin concentration should be ≤1 mg/L, and the post-dose concentration should be 3–5 mg/L.
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The pre-dose vancomycin concentration should be 15–20 mg/L.
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Adjust gentamicin and vancomycin doses according to measured levels and renal function.
Flucloxacillin dosing qualification
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The flucloxacillin dosing footnote specifies six daily doses when weight exceeds 85 kg.