Endocarditis medical therapy: Difference between revisions
Ahmed Zaghw (talk | contribs) /* Treatment Based Upon Infectious Agent{{cite journal | author = 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... |
Ahmed Zaghw (talk | contribs) /* Treatment Based Upon Infectious Agent{{cite journal | author = 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... |
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*Vancomycin can be administered to patients with a history of penicillin [[hypersensitivity]]. | *Vancomycin can be administered to patients with a history of penicillin [[hypersensitivity]]. | ||
*Dose: 30 mg/kg I.V. daily in divided doses q. 12 hour for 4 weeks. | *Dose: 30 mg/kg I.V. daily in divided doses q. 12 hour for 4 weeks. | ||
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Revision as of 19:20, 15 January 2014
Endocarditis Microchapters |
Diagnosis |
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Treatment |
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease |
Case Studies |
Endocarditis medical therapy On the Web |
Risk calculators and risk factors for Endocarditis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Ahmed Zaghw, M.D. [3]
Overview
Blood cultures should be drawn prior to instituting antibiotics to identify the etiologic agent and to determine its antimicrobial susceptibility. Older antibiotics such as penicillin G, ampicillin, nafcillin, cefazolin, gentamycin, ceftriaxone, rifampin and vancomycin are the mainstays of therapy.
Timing of Initiation of Antibiotics
Antibiotic therapy for subacute or indolent disease can be delayed until results of blood cultures are known; in fulminant infection or valvular dysfunction requiring urgent surgical intervention, begin empirical antibiotic therapy promptly after blood cultures have been obtained.
Duration of Antibiotic Therapy
The duration for native valve endocarditis is often 4 weeks. For prosthetic valve endocarditis (including the presence of a valve ring), treatment should be continued for 6 to 8 weeks. For each infective agent, the preferred antimicrobial agent, dose, and duration is listed below.
Empirical Antibiotic Therapy
- Antibiotic therapy for subacute hemodynamically stable disease, and in those who have received antibiotics recently can be delayed waiting the results of blood cultures, as this delay allows an additional blood cultures without the confounding effect of empiric treatment, which is very important in determining the causing pathogens.[1]
- On the other hand, 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.
- Consultation with an infectious disease specialist for the selection of one of the antibiotic regimens is recommended (see therapy for culture-negative endocarditis). [2]
Treatment Based Upon Infectious Agent[3]
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.
Vancomycin
- Vancomycin can be administered to patients with a history of penicillin hypersensitivity.
- Dose: 30 mg/kg I.V. daily in divided doses q. 12 hour for 4 weeks.
Relatively Penicillin-Resistant Streptococci
EnterococciIn general, treatment of enterococcal endocarditis requires combination therapy with two antibiotics: Penicillin G + Gentamicin
Ampicillin + Gentamicin
Vancomycin + Gentamicin
Staphylococci (Methicillin Susceptible) in the Absence of Prosthetic MaterialNafcillin or Oxacillin + Gentamicin (optional)
Cefazolin + Gentamicin (optional)
Vancomycin
Staphylococci (Methicillin Resistant) in the Absence of Prosthetic MaterialVancomycin
Staphylococci (Methicillin Susceptible) in the Presence of Prosthetic MaterialNafcillin or Oxacillin + Rifampin + Gentamicin
Staphylococci (Methicillin Resistant) in the Presence of Prosthetic MaterialVancomycin + Rifampin + Gentamicin
HACEK OrganismsHACEK organisms are more indolent and the infection is less complicated. Ceftriaxone or another Third-Generation Cephalosporin
Ampicillin-SulbactamCiprofloxacin
Culture Negative EndocarditisPatients should be divided into 2 groups: Patients who Received Antibiotic Therapy before the Blood Culture being Drawn
Patients with Culture-Negative Endocarditis and Suspected Infection with Uncommon Endocarditis Pathogens
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