| Organism | Treatment | Therapy Length | |
| Strep viridans | Native | Prosthetic | |
| PCN-G | 4 | 6 | |
| PCN-G + gent | 2 | 6 | |
| ceftriaxone | 4 | 6 | |
| ceftriaxone + gent | 2 | 6 | |
| vanc (last resort) | 4 | 6 | |
| MSSA | oxacillin or nafcillin (add gent and rifampin in prosthetic valves) | 6 | >=6 |
| cefazolin if allergic (add gent and rifampin in prosthetic valves) | 6 | >=6 | |
| vanc (last resort) | 6 | >=6 | |
| MRSA | vanc (add gent and rifampin in prosthetic valves) | 6 | >=6 |
| daptomycin in native valves only | 6 | >=6 | |
| enterococcus | PCN-G or ampicillin + gent | 4-6 | 6 |
| vanc (only if unable to take B-lactam) + gent | 6 | 6 | |
| ampicillin + ceftriaxone | 6 | 6 | |
| PCN Resistant Enterococcus | vanc + gent | 6 | 6 |
| Multi-resistant enterococcus | linezolid | >=6 | >=6 |
| daptomycin | >=6 | >=6 | |
| HACEK Group | ceftriaxone | 4 | 4 |
| ampicillin/sulfbactam | 4 | 4 | |
| fluoroquinolones (cipro, moxi, levo) | 4 | 4 |
Take home points:
- For strep endocarditis, adding gent shortens treatment to 2 weeks from 4 weeks.
- add rifampin in prosthetic valves
- Staph never gets an aminoglycoside in native valves (always in prosthetic)
- enterococcus always gets gent
- no daptomycin in left-side prosthetic valve endocarditis
Prophylaxis:
- Only in patients with a history of infective endocarditis, prosthetic valves, unrepaired congenital heart disease or repaired congenital heart disease with the use of prosthetic materials during the previous 6 months or cardiac transplant patients.
- Prophylaxis only for dental procedures that involve manipulation of the gingival tissue or periapical region or perforation of the oral mucosa. One single dose of amoxicillin (preferred) or cephalexin, clindamycin, azithromycin or clarithromycin.