If native heart valve, refer to the NHSGGC poster above for empirical endocarditis treatment, but if prosthetic heart valve then see below for more detailed treatment guidance than what is on the NHSGGC poster. 

Endocarditis Empirical therapy

Prosthetic heart valve infections are usually:

  • Staphylococcal (Coagulase negative / MSSA / MRSA)
  • Enterococcal
Antibiotic Therapy (before prescribing, carefully read the Notes / Comments section below)

Vancomycin IV (dosing info here)


Gentamicin* IV (synergistic dosing - see the GGC guideline)

Duration: Review microbiology results at 72 hours and discuss course duration with microbiology / infectious diseases team.

Notes / Comments

If Meticillin Sensitive Staphylococcus aureus (MSSA) isolated, switch from IV vancomycin to Flucloxacillin IV 2g 6 hourly if <85kg (or if ≥85kg 2g 4 hourly) unless true penicillin allergy.

Discuss with microbiology at 72 hours the need for oral rifampicin:

  • ≤70kg 450mg 12 hourly
  • >70kg 600mg 12 hourly

With rifampicin:

  • Check for drug interactions (BNF Appendix 1).
  • Caution if pre-existing liver disease.
  • Must not be used as monotherapy.


Guideline reviewed: September 2023

Page updated: November 2023