Sandbox endocarditis: Difference between revisions

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| ||'''''<u>Native valve</u>'''''||
| ||'''''<u>Native valve</u>'''''||
|-
|-
| '''Ampicillin-sulbactam'''||12 g per 24 h IV in 4 equally divided doses||4–6
| '''[[Ampicillin sulbactam]]'''||12 g per 24 h IV in 4 equally divided doses||4–6
|-
|-
|  || '''''plus''''' ||
|  || '''''plus''''' ||
|-
|-
| '''Gentamicin sulfate'''|| 3 mg per kg per 24 h IV/IM in 3 equally divided doses||4–6
| '''[[Gentamicin|Gentamicin sulfate]]'''|| 3 mg per kg per 24 h IV/IM in 3 equally divided doses||4–6
|-
|-
|  || '''or''' ||
|  || '''or''' ||
|-
|-
| '''Vancomycin'''||30 mg per kg per 24 h IV in 2 equally divided doses||4–6
| '''[[Vancomycin]]'''||30 mg per kg per 24 h IV in 2 equally divided doses||4–6
|-
|-
|  || '''''plus''''' ||
|  || '''''plus''''' ||
|-
|-
| '''Gentamicin sulfate'''||3 mg per kg per 24 h IV/IM in 3 equally divided doses||4–6
| '''[[Gentamicin|Gentamicin sulfate]]'''||3 mg per kg per 24 h IV/IM in 3 equally divided doses||4–6
|-
|-
|  || '''''plus''''' ||
|  || '''''plus''''' ||
|-
|-
| '''Ciprofloxacin'''||1000 mg per 24 h PO or 800 mg per 24 h IV in 2 equally divided doses||4–6
| '''[[Ciprofloxacin]]'''||1000 mg per 24 h PO or 800 mg per 24 h IV in 2 equally divided doses||4–6
|-
|-
| ||'''Pediatric dose''':  
| ||'''Pediatric dose''':  
*'''Ampicillin-sulbactam''' 300 mg per kg per 24 h IV in 4–6 equally divided doses  
*'''[[Ampicillin sulbactam]]''' 300 mg per kg per 24 h IV in 4–6 equally divided doses  
*'''Gentamicin''' 3 mg per kg per 24 h IV/IM in 3 equally divided doses  
*'''[[Gentamicin]]''' 3 mg per kg per 24 h IV/IM in 3 equally divided doses  
*'''Vancomycin''' 40 mg per kg per 24 h in 2 or 3 equally divided doses  
*'''[[Vancomycin]]''' 40 mg per kg per 24 h in 2 or 3 equally divided doses  
*'''Ciprofloxacin''' 20–30 mg per kg per 24 h IV/PO in 2 equally divided doses  
*'''[[Ciprofloxacin]]''' 20–30 mg per kg per 24 h IV/PO in 2 equally divided doses  
|-
|-
| ||'''''<u>Prosthetic valve (early, ≤ 1y)</u>'''''||
| ||'''''<u>Prosthetic valve (early, ≤ 1y)</u>'''''||
|-
|-
| '''Vancomycin'''||30 mg per kg per 24 h IV in 2 equally divided doses||6
| '''[[Vancomycin]]'''||30 mg per kg per 24 h IV in 2 equally divided doses||6
|-
|-
| ||'''''plus'''''||
| ||'''''plus'''''||
|-
|-
| '''Gentamicin sulfate'''||3 mg per kg per 24 h IV/IM in 3 equally divided doses||2
| '''[[Gentamicin|Gentamicin sulfate]]'''||3 mg per kg per 24 h IV/IM in 3 equally divided doses||2
|-
|-
| ||'''''plus'''''||
| ||'''''plus'''''||
|-
|-
|'''Cefepime'''||6 g per 24 h IV in 3 equally divided doses||6
|'''[[Cefepime]]'''||6 g per 24 h IV in 3 equally divided doses||6
|-
|-
| ||'''''plus'''''||
| ||'''''plus'''''||
|-
|-
| '''Rifampin'''||900 mg per 24 h PO/IV in 3 equally divided doses||6
| '''[[Rifampin]]'''||900 mg per 24 h PO/IV in 3 equally divided doses||6
|-
|-
| ||'''Pediatric dose''':
| ||'''Pediatric dose''':
*'''Vancomycin''' 40 mg per kg per 24 h IV in 2 or 3equally divided doses
*'''[[Vancomycin]]''' 40 mg per kg per 24 h IV in 2 or 3equally divided doses
*'''Gentamicin''' 3 mg per kg per 24 h IV/IM in 3 equally divided doses
*'''[[Gentamicin]]''' 3 mg per kg per 24 h IV/IM in 3 equally divided doses
*'''Cefepime''' 150 mg per kg per 24 h IV in 3 equally divided doses
*'''[[Cefepime]]''' 150 mg per kg per 24 h IV in 3 equally divided doses
*'''Rifampin''' 20 mg per kg per 24 h PO/IV in 3 equally divided doses
*'''[[Rifampin]]''' 20 mg per kg per 24 h PO/IV in 3 equally divided doses
|-
|-
| ||'''<u>Prosthetic valve (late—greater than 1 y)</u>'''||'''Same regimens as listed above for native valve endocarditis'''
| ||'''<u>Prosthetic valve (late—greater than 1 y)</u>'''||'''Same regimens as listed above for native valve endocarditis'''
Line 64: Line 64:
| ||'''<u>Suspected Bartonella, culture negative</u>'''
| ||'''<u>Suspected Bartonella, culture negative</u>'''
|-
|-
|'''Ceftriaxone sodium'''||2 g per 24 h IV/IM in 1 dose||6
|'''[[Ceftriaxone sodium]]'''||2 g per 24 h IV/IM in 1 dose||6
|-
|-
| ||'''''plus'''''||
| ||'''''plus'''''||
|-
|-
| '''Gentamicin sulfate'''||3 mg per kg per 24 h IV/IM in 3 equally divided doses||2
| '''[[Gentamicin|Gentamicin sulfate]]'''||3 mg per kg per 24 h IV/IM in 3 equally divided doses||2
|-
|-
| ||'''''with/without'''''||
| ||'''''with/without'''''||
|-
|-
| '''Doxycycline'''||200 mg per kg per 24 h IV/PO in 2 equally divided doses||6
| '''[[Doxycycline]]'''||200 mg per kg per 24 h IV/PO in 2 equally divided doses||6
|-
|-
| ||'''Documented Bartonella, culture positive'''||
| ||'''Documented Bartonella, culture positive'''||
|-
|-
| '''Doxycycline'''||200 mg per 24 h IV or PO in 2 equally divided doses||6
| '''[[Doxycycline]]'''||200 mg per 24 h IV or PO in 2 equally divided doses||6
|-
|-
| ||'''''plus'''''||
| ||'''''plus'''''||
|-
|-
| '''Gentamicin sulfate'''||3 mg per kg per 24 h IV/IM in 3 equally divided doses||2
| '''[[Gentamicin|Gentamicin sulfate]]'''||3 mg per kg per 24 h IV/IM in 3 equally divided doses||2
|-
|-
| ||'''Pediatric dose''':
| ||'''Pediatric dose''':
*'''Ceftriaxone''' 100 mg per kg per 24 h IV/IM once daily
*'''[[Ceftriaxone]]''' 100 mg per kg per 24 h IV/IM once daily
*'''Gentamicin''' 3 mg per kg per 24 h IV/IM in 3 equally divided doses
*'''[[Gentamicin]]''' 3 mg per kg per 24 h IV/IM in 3 equally divided doses
*'''Doxycycline''' 2–4 mg per kg per 24 h IV/PO in 2 equally divided doses
*'''[[Doxycycline]]''' 2–4 mg per kg per 24 h IV/PO in 2 equally divided doses
*'''Rifampin''' 20 mg per kg per 24 h PO/IV in 2 equally divided doses
*'''[[Rifampin]]''' 20 mg per kg per 24 h PO/IV in 2 equally divided doses
|-
|-
|}
|}

Revision as of 04:24, 14 January 2014

Empirical Antibiotic Therapy

  • Although antibiotic therapy for subacute disease can be delayed till the result of blood culture, the rapid progression of acute cases necessitate the start of empirical treatment antibiotic therapy once the blood cultures have been collected.
  • Empirical therapy is needed for all likely pathogens, certain antibiotic agents, including aminoglycosides, is preferably avoided for its toxic effects.
  • Clinical course of infection beside the epidemiological features should be considered upon selecting empirical treatment regimen.
Regimen Dosage and Route Duration(wk)
Native valve
Ampicillin sulbactam 12 g per 24 h IV in 4 equally divided doses 4–6
plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 4–6
or
Vancomycin 30 mg per kg per 24 h IV in 2 equally divided doses 4–6
plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 4–6
plus
Ciprofloxacin 1000 mg per 24 h PO or 800 mg per 24 h IV in 2 equally divided doses 4–6
Pediatric dose:
  • Ampicillin sulbactam 300 mg per kg per 24 h IV in 4–6 equally divided doses
  • Gentamicin 3 mg per kg per 24 h IV/IM in 3 equally divided doses
  • Vancomycin 40 mg per kg per 24 h in 2 or 3 equally divided doses
  • Ciprofloxacin 20–30 mg per kg per 24 h IV/PO in 2 equally divided doses
Prosthetic valve (early, ≤ 1y)
Vancomycin 30 mg per kg per 24 h IV in 2 equally divided doses 6
plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 2
plus
Cefepime 6 g per 24 h IV in 3 equally divided doses 6
plus
Rifampin 900 mg per 24 h PO/IV in 3 equally divided doses 6
Pediatric dose:
  • Vancomycin 40 mg per kg per 24 h IV in 2 or 3equally divided doses
  • Gentamicin 3 mg per kg per 24 h IV/IM in 3 equally divided doses
  • Cefepime 150 mg per kg per 24 h IV in 3 equally divided doses
  • Rifampin 20 mg per kg per 24 h PO/IV in 3 equally divided doses
Prosthetic valve (late—greater than 1 y) Same regimens as listed above for native valve endocarditis
Suspected Bartonella, culture negative
Ceftriaxone sodium 2 g per 24 h IV/IM in 1 dose 6
plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 2
with/without
Doxycycline 200 mg per kg per 24 h IV/PO in 2 equally divided doses 6
Documented Bartonella, culture positive
Doxycycline 200 mg per 24 h IV or PO in 2 equally divided doses 6
plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 2
Pediatric dose:
  • Ceftriaxone 100 mg per kg per 24 h IV/IM once daily
  • Gentamicin 3 mg per kg per 24 h IV/IM in 3 equally divided doses
  • Doxycycline 2–4 mg per kg per 24 h IV/PO in 2 equally divided doses
  • Rifampin 20 mg per kg per 24 h PO/IV in 2 equally divided doses

Treatment Based Upon Infectious Agent[1]

Penicillin-Susceptible Strep Viridans and Other Nonenterococcal Streptococci

Penicillin G

  • If Minimum inhibitory concentration [MIC] <0.2 µg/ml.
  • Dose: 12–18 million units I.V. daily in divided doses q. 4 hour for 4 weeks.

Penicillin G + Gentamicin

  • Dose: Penicillin G, 12–18 million units I.V. daily in divided doses q. 4 hour for 4 weeks plus gentamicin, 3 mg/kg I.M. or I.V. daily in divided doses q. 8 hour for 2 weeks (peak serum concentration should be ~ 3 µg/ml and trough concentrations < 1 µg/ml).

Ceftriaxone

  • Dose: 2 g I.V. daily as a single dose for 2 weeks.

References

  1. ↑ Baddour Larry M., Wilson Walter R., Bayer Arnold S., Fowler Vance G. Jr, Bolger Ann F., Levison Matthew E., Ferrieri Patricia, Gerber Michael A., Tani Lloyd Y., Gewitz Michael H., Tong David C., Steckelberg James M., Baltimore Robert S., Shulman Stanford T., Burns Jane C., Falace Donald A., Newburger Jane W., Pallasch Thomas J., Takahashi Masato, Taubert Kathryn A. (2005). "Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association-Executive Summary: Endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): 3167–84. PMID 15956145.
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