What is the treatment for prosthetic valve endocarditis (PVE) caused by methicillin-sensitive S aureus?

Updated: Jan 03, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

PVE caused by MSSA should be treated as follows:

  • Administer nafcillin or oxacillin at 2 g IV every 4 hours for 6 weeks or longer
  • Alternatively, administer cefazolin at 2 g IV every 8 hours for 6 weeks or longer
  • Each of these options should be combined with rifampin at 300 mg orally every 8 hours for 6 weeks or longer and with gentamicin at 1 mg/kg (based on ideal body weight) IM or IV every 8 hours for the first 2 weeks
  • PVE caused by MRSA should be treated with vancomycin at 30 mg/kg (not to exceed 2 g/d unless serum levels are monitored) for 6 weeks or longer combined with rifampin and gentamicin as outlined above; a peak vancomycin level of 30-45 mcg/mL should be attained 1 hour after completion of the IV infusion; a significant concern is that MRSA may become resistant to vancomycin.

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