Version July 2025
| Pre-operative antibiotic plan | Timing of valve replacement surgery | Post-operative antibiotic regimen (assuming all infected valve tissue was removed) | |
| Immunocompetent patients | Immunocompromised patients | ||
| 12 weeks of doxycycline (or azithromycin) plus 6 weeks of rifampin (preferred regimen) | During first 6 weeks of antibiotic regimen | Complete a total 6-week course of doxycycline (or azithromycin) and rifampin (including the preoperative course); if surgery was performed between weeks 4 through 6, give 2 weeks of post-operative doxycycline (or azithromycin) and rifampin | Complete the total 12-week course of doxycycline (or azithromycin) and 6-week course of rifampin |
| During weeks 7 through 10 of antibiotic regimen (ie, after rifampin has been completed) | Give an additional 2-week course of doxycycline (or azithromycin) after surgery | Complete the total 12-week course of doxycycline (or azithromycin) | |
| During the last 2 weeks of antibiotics or after completion of the full 12-week course | Give an additional 2-week course of doxycycline (or azithromycin) after surgery | Give an additional 2-week course of doxycycline (or azithromycin) after surgery | |
| 12 weeks of doxycycline (or azithromycin) plus 2 weeks of gentamicin | During first 2 weeks of antibiotic regimen | Complete the total 12-week course of doxycycline (or azithromycin), but discontinue gentamicin after surgery* | Complete the total 12-week course of doxycycline (or azithromycin), but discontinue gentamicin after surgery* |
| During weeks 3 through 10 of antibiotic regimen (ie, after gentamicin has been completed) | Complete the total 12-week course of doxycycline (or azithromycin) | Complete the total 12-week course of doxycycline (or azithromycin) | |
| During the last 2 weeks of antibiotics or after completion of the full 12-week course | Give an additional 2-week course of doxycycline (or azithromycin) after surgery | Give an additional 2-week course of doxycycline (or azithromycin) after surgery | |
| 24 weeks of doxycycline (or azithromycin) | During the first 22 weeks of antibiotic course | Complete the total 24-week course of doxycycline (or azithromycin) | Complete the total 24-week course of doxycycline (or azithromycin) |
| During the last 2 weeks of antibiotics or after completion of the full 24-week course | Give an additional 2-week course of doxycycline (or azithromycin) after surgery | Give an additional 2-week course of doxycycline (or azithromycin) after surgery | |
| No Bartonella treatment given prior to surgery¶ | Prior to any Bartonella treatment | Give 6 weeks of doxycycline plus 6 weeks of rifampin after surgery (if rifampin is not an option, 2 weeks of gentamicin is an alternative with careful monitoring) | Give 12 weeks of doxycycline plus 6 weeks of rifampin after surgery (if rifampin is not an option, 2 weeks of gentamicin is an alternative with careful monitoring) |
* We usually discontinue gentamicin in the post-operative setting due to increased risk of nephrotoxicity following surgery.
¶ These cases usually arise when the diagnosis of Bartonella endocarditis is made post-operatively.