Infective endocarditis caused by oral streptococci or the Streptococcus gallolyticus group requires a carefully selected antibiotic regimen. When the patient carries a documented allergy to beta-lactams, the standard first-line approach must be replaced and the regimen adapted for native (NVE) or prosthetic valve (PVE) disease.
This protocol applies when infective endocarditis is caused by oral streptococci or Streptococcus gallolyticus group and the patient has an allergy to beta-lactams. Beta-lactam allergy is the defining constraint that drives the entire treatment selection in this setting.
Vancomycin is the central agent in the recommended regimen for these patients. The treatment duration and whether combination therapy is added depends on whether the endocarditis involves a native or prosthetic valve — the full structured regimen, including the combination strategy for PVE, is available in the complete protocol.
In patients allergic to beta-lactams and with IE due to oral streptococci and S. gallolyticus, vancomycin for 4 weeks in NVE or for 6 weeks in PVE is recommended using the following doses:
In patients with PVE due to oral streptococci and S. gallolyticus and who are allergic to beta-lactams, vancomycin for 6 weeks combined with gentamicin for 2 weeks is recommended using the following doses:
DOI: 10.1093/eurheartj/ehad193
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