What is the recommended dose of Amoxicillin (amoxicillin) for the treatment of endocarditis?

From the Guidelines

The recommended dose of Amoxicillin for the treatment of endocarditis is 100-200 mg/kg/day i.v. in 4-6 doses, as stated in the 2015 ESC guidelines for the management of infective endocarditis 1.

Key Considerations

• The dosage may vary depending on the specific strain of bacteria and the patient's condition, with higher doses (200 mg/kg/day) recommended for strains relatively resistant to penicillin (MIC 0.250-2 mg/L) 1.
• The treatment duration is typically 4 weeks for native valve endocarditis and 6 weeks for prosthetic valve endocarditis 1.
• Amoxicillin is often used in combination with other antibiotics, such as gentamicin, to enhance its effectiveness 1.

Important Notes

• Patients should be monitored for signs of allergic reactions, kidney function, and clinical improvement during treatment 1.
• Blood cultures should be repeated to confirm clearance of bacteremia 1.
• In penicillin-allergic patients, alternative regimens with ceftriaxone or vancomycin would be considered 1.

Dosage and Administration

• The recommended dosage of Amoxicillin is 100-200 mg/kg/day i.v. in 4-6 doses, with a maximum dose not exceeding adult doses for pediatric patients 1.
• The dosage may need to be adjusted based on renal function and serum gentamicin concentrations, which should be monitored once a week 1.

From the Research

Recommended Dose of Amoxicillin for Endocarditis

• The recommended dose of amoxicillin for the treatment of endocarditis is not explicitly stated in the provided studies, but it can be inferred from the study 2 that high doses of amoxicillin are recommended for most cases of infective endocarditis.
• The study 2 mentions that patients received amoxicillin as continuous infusion, with a mean daily dose of 10.0 ± 3.3 g/day in the TDM group and 11.3 ± 2.0 g/day in the group without TDM.
• The study 3 mentions that oral amoxicillin with gentamicin has been used to treat enterococcal endocarditis, but it does not provide specific dosage information.
• The study 4 suggests that guidelines recommend treating fully penicillin-susceptible Enterococcus faecalis strains causing infective endocarditis with amoxicillin combined with gentamicin, but it does not provide specific dosage information.

Comparison of Antibiotic Regimens

• The study 5 compared different antibiotic regimens for the treatment of infective endocarditis, but it did not find conclusive differences between groups due to the low quality of evidence.
• The study 6 mentions that the use of aminoglycosides for the treatment of endocarditis has been dramatically reduced over the last 20 years, and that they should be administered once daily, and no longer than 2 weeks.
• The study 4 found that patients treated with combination gentamicin therapy had better clinical outcomes than patients treated with monotherapy, but it also found that low-dose gentamicin regimens were associated with acute kidney injury.

Therapeutic Drug Monitoring

• The study 2 found that amoxicillin therapeutic drug monitoring (TDM) was associated with a reduction in daily doses, with no impact on adverse events and prognosis.
• The study 2 suggests that individualized treatment of infective endocarditis through TDM may contribute to decreased use of antibiotics.