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IE – streptococcal treatment — RACP Paediatrics MCQ

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ModerateCardiologyIE – streptococcal treatmentRACP Paediatrics

The same child has blood cultures growing viridans streptococci. Echocardiogram confirms vegetations on the aortic valve with moderate aortic regurgitation. What is the most appropriate empirical antibiotic regimen for native valve endocarditis due to streptococci?

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Correct answer: D — IV benzylpenicillin + IV gentamicin

For native valve IE caused by penicillin-susceptible streptococci, IV benzylpenicillin plus IV gentamicin is the standard regimen per Australian Therapeutic Guidelines. Gentamicin provides synergistic bactericidal activity. Duration is typically 4 weeks of penicillin with 2 weeks of gentamicin. Vancomycin is used for penicillin-allergic patients.

Reference: Australian Therapeutic Guidelines – 2024 – Antibiotic; RCH Melbourne – 2023 – IE CPG