Do you add gentamicin when treating prosthetic valve endocarditis secondary to viridans group Streptococcus with a penicillin-intermediate isolate (MIC >0.125 - <0.5)?   

No, we do not treat patients with such infections with a combination of penicillin and gentamicin. For these infections, we treat with ceftriaxone alone. Monotherapy with ceftriaxone is a more reasonable option than a combination of penicillin and gentamicin because we have every reason to consider...

Thanks for the helpful answer by Dr. Shrestha. I also abandoned gentamicin a few years ago. Too toxic, especially for a contemplated duration of 6 weeks, in my very elderly population, most of whom have diabetes and vascular disease. I think there is very good data even since the 1980s that in STAP...

Usually use a double B-lactam (e.g., ceftriaxone, amoxicillin). The majority of PVEs (Strep and others) are in more elderly patients who are especially prone to renal or vestibular toxicity from prolonged courses of aminoglycosides. Genta (or tobra) is reserved for those rare, desperate cases with e...