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| *Consultation with an infectious disease specialist for the selection of one of the antibiotic regimens is recommended (see therapy for culture-negative endocarditis). <ref name="Baddour-2005">{{Cite journal | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = 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: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref> | | *Consultation with an infectious disease specialist for the selection of one of the antibiotic regimens is recommended (see therapy for culture-negative endocarditis). <ref name="Baddour-2005">{{Cite journal | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = 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: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref> |
|
| |
| ==Treatment Based Upon Infectious Agent<ref name= Baddour>{{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 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.| title = 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. | journal = Circulation | volume = 111 | issue = 23 | pages = 3167-84 | year = 2005 | id = PMID 15956145 }}</ref>==
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| ==Streptococci==
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|
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| <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
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|
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| {|
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| | valign=top |
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| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
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| <font color="#FFF">
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| '''Native Valve Endocarditis Caused by Viridans Group Streptococci and Streptococcus Bovis'''
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| </font>
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| </div>
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|
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| <div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Viridans Group Streptococci and Streptococcus Bovis Highly Penicillin-Susceptible'''
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| </font>
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| </div>
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|
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| <div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Viridans Group Streptococci and Streptococcus Bovis Relatively Penicillin Resistant (MIC >0.12 μg/mL- ≤ 0.5 μg/mL)'''
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| </font>
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| </div>
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|
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| <div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
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| <font color="#FFF">
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| '''Prosthetic Valves Endocarditis Caused by Viridans Group Streptococci and Streptococcus Bovis'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table13" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Viridans Group Streptococci and Streptococcus Bovis Penicillin-Susceptible Strain (MIC ≤ 0.12 μg/mL)'''
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| </font>
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| </div>
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|
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| <div class="mw-customtoggle-table14" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Viridans Group Streptococci and Streptococcus Bovis Penicillin Relatively or Fully Resistant Strain (MIC >0.12 μg/mL)'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table15" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Viridans Group Streptococci and Streptococcus bovis Relatively Penicillin-Resistant Streptococci (MIC 0.2–0.5 µg/ml)'''
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| </font>
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| </div>
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|
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| <div class="mw-customtoggle-table16" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Relatively Penicillin-Resistant Streptococci (MIC > 0.5 µg/ml)'''
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| </font>
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| </div>
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|
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| <div class="mw-customtoggle-table17" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Unable to tolerate Penicillin or Ceftriaxone'''
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| </font>
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| </div>
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|
| |
| |valign=top |
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table11" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
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| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Native Valve Endocarditis Caused by Highly Penicillin-Susceptible Viridans Group Streptococci and Streptococcus bovis}}
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Preferred Regimen</u>''''' ( 4 wks )
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
|
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] † 12–18 million U/24 h IV either continuously or in 4-6 equally divided doses x 4 Wks'''''<BR>''OR''<BR> ▸ '''''[[Ceftriaxone|Ceftriaxone sodium]] 2 g/24 h IV/IM in 1 dose x 4 Wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose ₳}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 200 000 U/kg q24h IV either continuously or in 4-6 equally divided doses x 4 Wks'''''<BR>''OR''<BR> ▸'''''[[Ceftriaxone]] 100 mg/kg q24 h IV/IM in 1 dose x 4 Wks'''''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Alternative Regimen</u>''''' ( 2 wks )
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]]‡ 12–18 million U/24 h IV either continuously or in 6 equally divided doses x 2 Wks'''''<BR>''OR''<BR> ▸ '''''[[Ceftriaxone|Ceftriaxone sodium]] 2 g/24 h IV/IM in 1 dose x 2 Wks'''''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 80%; background: #F8F8FF" align=left | '''''PLUS'''''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin| Gentamicin sulfate]] ฿ 3 mg/Kg per 24h 1 dose x 2 Wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 200 000 U/kg q24h IV in 4-6 equally divided doses x 2 Wks'''''<BR>''OR''<BR> ▸'''''[[Ceftriaxone]] 100 mg/kg q24 h IV/IM in 1 dose x 2 Wks'''''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 80%; background: #F8F8FF" align=left | '''''PLUS'''''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin| Gentamicin sulfate]] 3 mg/Kg per 24h 1 dose or 3 equally divided doses x 2 Wks'''''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Alternative Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Vancomycin|Vancomycin hydrochloride]] ¶ 15 mg/kg q12h IV x 4 Wks''''' <br> Doses should not to exceed 2 g/24 h unless concentrations in serum are inappropriately low
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left |▸'''''[[Vancomycin|Vancomycin hydrochloride]] 40 mg/kg per 24 h IV in 2–3 equally divided doses'''''
| |
| |-
| |
| |
| |
| Minimum inhibitory concentration ≤ 0.12 μg/mL.
| |
| :† Preferred in most patients >65 y or patients with impairment of 8th cranial nerve function or renal function.
| |
|
| |
| :₳ Pediatric dose should not exceed that of a normal adult.
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|
| |
| :‡ 2-wk regimen not intended for patients with known cardiac or extracardiac abscess or for those with creatinine clearance of <20 mL/min, impaired 8th cranial nerve function, or Abiotrophia, Granulicatella, or Gemella spp infection; gentamicin dosage should be adjusted to achieve peak serum concentration of 3-4 μg/mL and trough serum concentration of >1 μg/mL when 3 divided doses are used; nomogram used for single daily dosing.
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|
| |
| :¶ Vancomycin therapy recommended only for patients unable to tolerate penicillin or ceftriaxone; vancomycin dosage should be adjusted to obtain peak (1 h after infusion completed) serum concentration of 30–45 μg/mL and a trough concentration range of 10–15 μg/mL
| |
|
| |
| :฿ Other potentially nephrotoxic drugs (eg, nonsteroidal antiinflammatory drugs) should be used with caution in patients receiving gentamicin therapy. Although it is preferred that gentamicin (3 mg/kg) be given as a single daily dose to adult patients with endocarditis due to viridans group streptococci, as a second option, gentamicin can be administered daily in 3 equally divided doses.
| |
| |-
| |
| |}
| |
| |}
| |
| |valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="background: #FFFFFF;"
| |
| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
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| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Native Valve Endocarditis Caused by Strains of Viridans Group Streptococci and Streptococcus Bovis Relatively Resistant to Penicillin (MIC >0.12 μg/mL- ≤ 0.5 μg/mL))}}
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Preferred Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 24 million U/24 h IV either continuously or in 4–6 equally divided doses x 4 wks'''''<BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 2 g/24 h IV/IM in 1 dose x 4 wks'''''
| |
| |-
| |
| !style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 1 dose x 2 wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 300 000 U/kg per 24 h IV in 4–6 equally divided doses'''''<BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 100 mg/kg per 24 h IV/IM in 1 dose'''''
| |
| |-
| |
| !style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 1 dose or equally divided doses'''''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Alternative Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg per 24 h IV in 2 equally divided doses x 4 wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin|Vancomycin hydrochloride]] 40 mg/kg per 24 h IV or in 2 or 3 equally divided doses'''''
| |
| |-
| |
| |}
| |
| |}
| |
| |valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table13" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Penicillin-susceptible strain (MIC ≤ 0.12 g/mL)}}
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Preferred Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] † 24 million U/24 h IV either continuously or in 4–6 equally divided doses x 6 wks'''''<BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 2 g/24 h IV/IM in 1 dose x 6 wks'''''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''WITH OR WITHOUT''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin|Gentamicin sulfate]] ‡ 3 mg/kg per 24 h IV/IM in 1 dose x 2 wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 300 000 U/kg per 24 h IV in 4–6 equally divided doses'''''<BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 100 mg/kg IV/IM once daily'''''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''WITH OR WITHOUT''
| |
|
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸'''''[[Gentamicin]] 3 mg/kg per 24 h IV/IM, in 1 dose or 3 equally divided doses'''''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Alternative Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin|Vancomycin
| |
| hydrochloride]] 30 mg/kg per 24 h IV in 2 equally divided doses x 6 wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''40 mg/kg per 24 h IV or in 2 or 3 equally divided doses'''''
| |
| |-
| |
| |
| |
| *Dosages recommended are for patients with normal renal function.
| |
|
| |
| :† Penicillin or ceftriaxone together with gentamicin has not demonstrated superior cure rates compared with monotherapy with penicillin or ceftriaxone for patients with highly susceptible strain; gentamicin therapy should not be administered to patients with creatinine clearance of <30 mL/min.
| |
|
| |
| :‡ Although it is preferred that gentamicin (3 mg/kg) be given as a single daily dose to adult patients with endocarditis due to viridans group streptococci, as a second option, gentamicin can be administered daily in 3 equally divided doses.
| |
| |-
| |
| |}
| |
| |}
| |
|
| |
| |valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table14" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Penicillin Relatively or Fully Resistant Strain (MIC >0.12 >μg/mL)}}
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Preferred Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 24 million U/24 h IV either continuously or in 4–6 equally divided doses x 6 wks'''''<BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 2 g/24 h IV/IM in 1 dose x 6 wks'''''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 1 dose x 6 wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 300 000 U/kg per 24 h IV in 4–6 equally divided doses'''''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Alternative Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg per 24 h IV in 2 equally divided doses x 6 wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin|Vancomycin hydrochloride]] 40 mg/kg per 24 h IV or in 2 or 3 equally divided doses'''''
| |
| |-
| |
| |}
| |
| |}
| |
|
| |
| |valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table15" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Relatively Penicillin-Resistant Streptococci (MIC 0.2–0.5 µg/ml)}}
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Preferred Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G potassium]] 24 million U/24 h IV either continuously or in 4–6 equally divided doses X 4 Wks '''''<BR>''OR'' <BR>▸'''''[[Ceftriaxone]] 2 g/24 h IV/IM in 1 dose'''''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | AND
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg I.M. or I.V. daily in divided doses q. 8 hr X 2 Wks '''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G potassium]] 300 000 U/24 h IV in 4–6 equally divided doses X 4 Wks '''''<BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 100 mg/kg per 24 h IV/IM in 1 dose'''''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | AND
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg per 24 h IV/IM in 1 dose or 3 equally divided doses X 2 Wks'''''
| |
| |-
| |
| |}
| |
| |}
| |
| |valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table16" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Relatively Penicillin-Resistant Streptococci(MIC > 0.5 µg/ml, consider Enterococcal regimen)}}
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Preferred Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G potassium]] 24 million U/24 h IV either continuously or in 4–6 equally divided doses x 4 Wks '''''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg I.M. or I.V. daily in divided doses q. 8 hr x 2 Wks '''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G potassium]] 24 million U/24 h IV either continuously or in 4–6 equally divided doses x 4 Wks '''''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg I.M. or I.V. daily in divided doses q. 8 hr x 2 Wks '''''
| |
| |-
| |
| |}
| |
| |}
| |
| |valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table17" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Unable to Tolerate Aqueous crystalline penicillin G sodium or Ceftriaxone}}
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30 mg/kg per 24 h IV in 2 equally divided doses not to exceed 2 g/24 h, unless serum concentrations are inappropriately low '''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 40 mg/kg 24 h in 2 or 3 equally divided doses X 4 Wks '''''
| |
| |-
| |
| |}
| |
| |}
| |
| |}
| |
|
| |
| ==Enterococci==
| |
|
| |
| Native valve or prosthetic valve enterococcal endocarditis requires combination therapy with two antibiotics as the following:<ref name="Baddour-2005">{{Cite journal | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = 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: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref>
| |
|
| |
| <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
| |
|
| |
| {|
| |
| | valign=top |
| |
| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 40px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
| |
| <font color="#FFF">
| |
| '''Endocarditis Caused by Enterococci'''
| |
| </font>
| |
| </div>
| |
|
| |
| <div class="mw-customtoggle-table18" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Enterococci Strains Susceptible to Penicillin, Gentamicin, and Vancomycin'''
| |
| </font>
| |
| </div>
| |
|
| |
| <div class="mw-customtoggle-table19" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Enterococci Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin'''
| |
| </font>
| |
| </div>
| |
|
| |
| <div class="mw-customtoggle-table20" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Enterococci Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin'''
| |
| </font>
| |
| </div>
| |
|
| |
| <div class="mw-customtoggle-table21" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Enterococci Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin'''
| |
| </font>
| |
| </div>
| |
|
| |
| | valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table18" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Enterococci Strains Susceptible to Penicillin, Gentamicin, and Vancomycin}}
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Preferred Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 12 g/24 h I.V.in 6 equally divided doses x 4–6 Wks'''''<br> ''OR'' <br> ▸'''''[[Penicillin G sodium]] 18–30 million U. I.V. daily in 6 equally divided doses x 4–6 Wks'''''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left |▸'''''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 3 equally divided doses x 4-6 Wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 300 mg/kg per 24 h IV in 4–6 equally divided doses; X 4–6 Wks''''' <br>''OR''<br> ▸'''''[[Penicillin G sodium]] 300 000 U/kg per 24 h IV in 4–6 equally divided doses X 4–6 Wks'''''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left |▸'''''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 3 equally divided doses X 4-6 Wks'''''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Alternative Regimen</u>'''''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30 mg/kg I.V. daily in 2 equally divided doses x 6 Wks'''''<br> ''PLUS'' <br> ▸'''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 3 equally divided doses x 6 Wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30 mg/kg I.V. daily in divided doses q. 12 hour X 4–6 Wks'''''<br> ''PLUS'' <br> ▸'''''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 3 equally divided doses X 4-6 Wks'''''
| |
| |-
| |
| |
| |
| *Native valve: 4-wk therapy recommended for patients with symptoms of illness < 3 months.
| |
| *6-wk therapy recommended for patients with symptoms >3 months.
| |
| *Prosthetic valve or other prosthetic cardiac material: minimum of 6 wk of therapy recommended.
| |
| *Vancomycin therapy recommended only for patients unable to tolerate penicillin or ampicillin.
| |
| *6 wk of vancomycin therapy recommended because of decreased activity against enterococci.
| |
| |-
| |
| |}
| |
| |}
| |
| | valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table19" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Enterococci Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin}}
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Preferred Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 12 g/24 h I.V.in 6 equally divided doses x 4–6 Wks'''''<br> ''OR'' <br> ▸'''''[[Penicillin G sodium]] 24 million U. I.V. continuously or in 6 equally divided doses x 4–6 Wks'''''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left |▸'''''[[Streptomycin|Streptomycin sulfate]] 15 mg/kg per 24 h IV/IM in 2 equally divided doses x 4-6 Wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 300 mg/kg per 24 h IV in 4–6 equally divided doses; x 4–6 Wks''''' <br>''OR''<br> ▸'''''[[Penicillin G sodium]] 300 000 U/kg per 24 h IV in 4–6 equally divided doses x 4–6 Wks'''''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left |▸'''''[[Streptomycin|Streptomycin sulfate]] 20–30 mg/kg per 24 h IV/IM in 2 equally divided doses'''''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Alternative Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30 mg/kg I.V. daily in 2 equally divided doses x 6 Wks'''''<br> ''PLUS'' <br> ▸'''[[Streptomycin|Streptomycin sulfate]] 15 mg/kg per 24 h IV/IM in 2 equally divided doses x 4-6 Wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 40 mg/kg per 24 h IV in 2 or 3 equally divided doses X 4–6 Wks'''''<br>''PLUS''<br>▸'''''[[Streptomycin|Streptomycin sulfate]] 20–30 mg/kg per 24 h IV/IM in 2 equally divided doses'''''
| |
| |-
| |
| |
| |
| *Native valve: 4-wk therapy recommended for patients with symptoms of illness < 3 months.
| |
| *6-wk therapy recommended for patients with symptoms >3 months.
| |
| *Prosthetic valve or other prosthetic cardiac material: minimum of 6 wk of therapy recommended.
| |
| *Vancomycin therapy recommended only for patients unable to tolerate penicillin or ampicillin.
| |
| |-
| |
| |}
| |
| |}
| |
|
| |
| | valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table20" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|β-Lactamase–producing strain}}
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Preferred Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin sulbactam|Ampicillin-sulbactam]] 12 g/24 h IV in 4 equally divided doses x 6 Wks'''''<br> ''PLUS'' <br> ▸'''''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 3 equally divided doses x 6 Wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin sulbactam|Ampicillin-sulbactam]] 300 mg/kg per 24 h IV in 4 equally divided doses x 6 Wks''''' <br> ''PLUS'' <br> ▸'''''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 3 equally divided doses x 6 Wks'''''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Alternative Regimen</u>'''''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left |▸'''''[[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg per 24 h IV in 2 equally divided doses x 6 Wks'''''<br> ''PLUS'' <br> ▸'''''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 3 equally divided doses x 6 Wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin|Vancomycin hydrochloride]] 40 mg/kg per 24 h in 2 or 3 equally divided doses''''' <br> ''PLUS'' <br> ▸'''''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 3 equally divided doses x 6 Wks'''''
| |
| |-
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Intrinsic penicillin resistance}}
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left |▸'''''[[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg per 24 h IV in 2 equally divided doses x 6 Wks'''''<br> ''PLUS'' <br> ▸'''''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 3 equally divided doses x 6 Wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin|Vancomycin hydrochloride]] 40 mg/kg per 24 h in 2 or 3 equally divided doses''''' <br> ''PLUS'' <br> ▸'''''[[Gentamicin|Gentamicin sulfate]] 3 mg/kg per 24 h IV/IM in 3 equally divided doses x 6 Wks'''''
| |
| |-
| |
| |}
| |
| |}
| |
|
| |
| | valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table21" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|E faecium}}
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 1200 mg/24 h IV/PO in 2 equally divided doses x ≥8 Wks'''''<br> ''OR'' <br> ▸'''''[[Quinupristin dalfopristin|Quinupristin-dalfopristin]] 22.5 mg/kg per 24 h IV in 3 equally divided doses x ≥ 8 Wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 30 mg/kg per 24 h IV/PO in 3 equally divided doses ≥8 Wks''''' <br> ''OR'' <br> ▸'''''[[Quinupristin dalfopristin|Quinupristin-dalfopristin]] 22.5 mg/kg per 24 h IV in 3 equally divided doses ≥8 Wks'''''
| |
| |-
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF| E faecalis}}''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Preferred Regimen</u>'''''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Imipenem/cilastatin]] 2 g/24 h IV in 4 equally divided doses x ≥8 Wks'''''<br> ''PLUS'' <br> ▸'''''[[Ampicillin|Ampicillin sodium]] 12 g/24 h IV in 6 equally divided doses x ≥ 8 Wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Imipenem/cilastatin]] 60–100 mg/kg per 24 h IV in 4 equally divided doses x ≥8 Wks'''''<br> ''PLUS'' <br> ▸'''''[[Ampicillin|Ampicillin sodium]] 300 mg/kg per 24
| |
| h IV in 4–6 equally divided doses x ≥ 8 Wks'''''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Alternative Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone|Ceftriaxone sodium]] 4 g/24 h IV/IM in 2 equally divided doses x ≥8 Wks'''''<br> ''PLUS'' <br> ▸'''''[[Ampicillin|Ampicillin sodium]] 12 g/24 h IV in 6 equally divided doses x ≥ 8 Wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone|Ceftriaxone sodium]] 100 mg/kg per 24 h IV/IM in 2 equally divided doses x ≥8 Wks'''''<br>''PLUS''<br> ▸'''''[[Ampicillin|Ampicillin sodium]] 300 mg/kg per 24 h IV in 4–6 equally divided doses x ≥ 8 Wks'''''
| |
| |-
| |
| |
| |
| *Patients with endocarditis caused by these strains should be treated in consultation with an infectious diseases specialist.
| |
| *Cardiac valve replacement may be necessary for bacteriologic cure.
| |
| *Cure with antimicrobial therapy alone may be < 50%
| |
| *Severe, usually reversible thrombocytopenia may occur with use of linezolid, especially after 2 wk of therapy.
| |
| *Quinupristin-dalfopristin only effective against E faecium and can cause severe myalgias, which may require discontinuation of therapy
| |
| *Only small no. of patients have reportedly been treated with imipenem/cilastatin-ampicillin or ceftriaxone + ampicillin.
| |
| |-
| |
| |}
| |
| |}
| |
| |}
| |
|
| |
| ==Staphylococci==
| |
|
| |
| {|
| |
| | valign=top |
| |
| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
| |
| <font color="#FFF">
| |
| '''Native Valve Endocarditis caused by Staphylococci in the Absence of Prosthetic Material'''
| |
| </font>
| |
| </div>
| |
|
| |
| <div class="mw-customtoggle-table23" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Staphylococci (Methicillin Susceptible)'''
| |
| </font>
| |
| </div>
| |
|
| |
| <div class="mw-customtoggle-table24" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Staphylococci (Methicillin-resistant) with Penicillin G Anaphylactoid Hypersensitivity '''
| |
| </font>
| |
| </div>
| |
|
| |
| <div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
| |
| <font color="#FFF">
| |
| '''Prosthetic Valves Endocarditis or Other Prosthetic Material Caused by Staphylococci'''
| |
| </font>
| |
| </div>
| |
|
| |
| <div class="mw-customtoggle-table25" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Oxacillin-Susceptible Strains '''
| |
| </font>
| |
| </div>
| |
|
| |
| <div class="mw-customtoggle-table26" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Oxacillin-Resistant Strains'''
| |
| </font>
| |
| </div>
| |
|
| |
| |valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table23" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Staphylococci (Methicillin Susceptible)}}
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Preferred Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] or [[Oxacillin]] † 12 g I.V. daily in equally divided doses x 6 Wks '''''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | PLUS (optional)
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin|Gentamicin sulfate]] ‡ 3 mg/kg per 24 h IV/IM in 2-3 equally divided doses x 3-5 days '''''
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Altenative Regimen</u>'''''( in non anaphylactoid [[Penicillin]] hypersensitivity)
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefazolin]] 6 g/ 24 h I.V. in 3 divided doses x 6 wks '''''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | PLUS (optional)
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg per 24 h IV/IM in 2-3 equally divided doses x 3-5 days '''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatrics dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] or [[oxacillin]] 200 mg/kg per 24 h IV in 4–6 equally divided doses x 4-6 wks'''''<BR>''OR ( in non anaphylactoid [[Penicillin]] hypersensitivity)'' <BR> ▸'''''[[Cefazolin]] 100 mg/kg per 24 h IV in 3 equally divided doses x 4-6 wks'''''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | AND (optional)
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg per 24 h IV/IM in 3 equally divided doses'''''
| |
| |-
| |
| |
| |
| :† Penicillin G 24 million U/24 h IV in 4 to 6 equally divided doses may be used in place of nafcillin or oxacillin if strain is penicillin susceptible (MIC ≤ 0.1 μg/mL) and does not produce β-lactamase.
| |
|
| |
| :‡ Gentamicin should be administered in close temporal proximity to vancomycin, nafcillin, or oxacillin dosing.
| |
| |-
| |
| |}
| |
| |}
| |
|
| |
| |valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table24" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Staphylococci (Methicillin-resistant) <BR>(in anaphylactoid Penicillin hypersensitivity)}}
| |
| |-
| |
| !style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | '''''<u>Preferred Regimen</u>'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| ! style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30 mg/kg per 24 h IV in 2 equally divided doses x 6 wks''''' <br> Adjust vancomycin dosage to achieve 1-h serum concentration of 30–45 > g/mL and trough concentration of 10–15 >g/mL
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatrics dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 40 mg/kg per 24 h IV in 2 or 3 equally divided doses x 6 wks '''''
| |
| |-
| |
| |}
| |
| |}
| |
|
| |
| |valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table25" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Oxacillin-susceptible strains}}
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] or [[oxacillin]] 2 g q4h IV x ≥6 weeks'''''<BR>''PLUS''<BR> ▸ '''''[[Rifampin]] 300 mg q8h IV/PO x ≥6 weeks''''' <BR>''PLUS''<BR> ▸ '''''[[Gentamicin]] 3 mg/kg per 24 h IV/IM in 2 or 3 equally divided doses x 2 weeks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸'''''[[Nafcillin]] or [[oxacillin]] 200 mg/kg per 24 h IV in 4–6 equally divided doses'''''<BR>''PLUS''<BR> ▸'''''[[Rifampin]] 20 mg/kg per 24 h IV/PO in 3 equally divided doses'''''<BR>''PLUS''<BR>▸'''''[[Gentamicin]] 1 mg/kg q8h IV/IM'''''
| |
| |-
| |
| |}
| |
| |}
| |
| |valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table26" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Oxacillin-resistant strains}}
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg q12h x ≥6 Wks'''''<BR>''PLUS''<BR> ▸ '''''[[Rifampin]] 300 mg q8h IV/PO x ≥6 Wks''''' <BR>''PLUS''<BR> ▸ '''''[[Gentamicin]] 3 mg/kg per 24 h IV/IM in 2 or 3 equally divided doses x 2 wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 40 mg/kg per 24 h IV in 2-3 equally divided doses x ≥6 wks'''''<BR>''PLUS''<BR> ▸'''''[[Rifampin]] 20 mg/kg per 24 h IV/PO in 3 equally divided doses x ≥6 wks'''''<BR>''PLUS''<BR>▸ '''''[[Gentamicin]] 1 mg/kg q8h IV/IM x 2 Wks'''''
| |
| |-
| |
| |}
| |
| |}
| |
| |}
| |
|
| |
| ==HACEK Organisms==
| |
|
| |
| [[HACEK organism]]s are more indolent and the infection is less complicated.
| |
| <ref name="Baddour-2005">{{Cite journal | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = 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: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref>
| |
| <div class="mw-collapsible-content">
| |
|
| |
| {|
| |
| | valign=top |
| |
| <div class="mw-customtoggle-table27" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 70px; line-height: 30px; width: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Therapy for Both Native and Prosthetic Valve Endocarditis Caused by HACEK Microorganisms'''
| |
| </font>
| |
| </div>
| |
|
| |
| |valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table27" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
| |
| ! style="height: 50px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Therapy for Both Native and Prosthetic Valve Endocarditis Caused by HACEK Microorganisms}}
| |
|
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone|Ceftriaxone sodium]] † 2 g/24 h IV/IM in 1 dose x 4 weeks'''''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''OR''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin sulbactam|Ampicillin- sulbactam]] ‡ 12 g/24 h IV in 4 equally divided doses x 4 weeks'''''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''OR''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] ‡¶ 500 mg q12h PO or 400 mg q12h IV x 4 weeks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 100 mg/kg per 24 h IV/IM once daily'''''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''OR''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸'''''[[Ampicillin sulbactam|Ampicillin- sulbactam]] 300 mg/kg per 24 h IV divided into 4 or 6 equally divided doses'''''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ''OR''
| |
| |-
| |
| |style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸'''''[[Ciprofloxacin]] 10-15 mg/kg q12h IV/PO '''''
| |
| |-
| |
| |
| |
| *HACEK: Haemophilus parainfluenzae, H aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae.
| |
|
| |
| :† Patients should be informed that IM injection of ceftriaxone is painful.
| |
| :‡ Dosage recommended for patients with normal renal function.
| |
| :¶ Fluoroquinolones are highly active in vitro against HACEK microorganisms. Published data on use of fluoroquinolone therapy for endocarditis caused by HACEK are minimal.
| |
| |-
| |
| |}
| |
| |}
| |
| |}
| |
|
| |
| ==Culture Negative Endocarditis==
| |
| *Clinical course of infection beside the epidemiological features should be considered upon selecting treatment regimen.
| |
|
| |
| *Patients should be divided into 2 groups:<ref name="Baddour-2005">{{Cite journal | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = 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: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref>
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|
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| ====Patients Who Received Antibiotic Therapy Before the Blood Culture====
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| *Patients with acute clinical presentations with native valve infection: coverage of S. aureus should be followed as detailed in proven staphylococcal disease.
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|
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| *Patients with subacute presentation: antibiotic coverage for S. aureus, viridians group streptococci, and enterococci should be considered.
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|
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| *Antibiotics for HACEK group of organism also should be considered.
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|
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| *Symptomatic patients with prosthetic valve and culture negative infection within 1 year of valve replacement should receive vancomycin to cover the oxacillin-resistant staphylococci.
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|
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| *Symptomatic patients with prosthetic valve and culture negative infection within 2 months of valve replacement should also receive cefepime for gram negative bacilli coverage.
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|
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| *Symptomatic patients with prosthetic valve more than 1 year, the most likely causing organisms are oxacillin-susceptible staphylococci, viridians group streptococci, and enterococci. Antibiotic coverage for those organisms should be continued for at least 6 weeks.
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|
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| ====Patients with Culture-Negative Endocarditis and Suspected Infection with Uncommon Endocarditis Pathogens====
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| *Examples of these pathogens include Bartonella species, Chlamydia species, Coxiella burnetii, Brucella species, Legionella species, Tropheryma whippleii, and non-Candida fungi.
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|
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| *The most common pathogens that have been reported with culture-negative endocarditis are [[Bartonella|Bartonella species]], [[Coxiella burnetii]], and [[Brucella|Brucella species]].
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|
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| *Antibiotic therapy for these pathogens should include aminoglycosides for at least 2 weeks.
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| *Therapeutic regimens for Bartonella endocarditis based on the [[Endocarditis causes|epidemiological risk]] and high index of suspicion.
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|
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| <div class="mw-collapsible mw-collapsed">
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|
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| ===Native Valve Culture Negative Endocarditis===
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|
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| <div class="mw-collapsible-content">
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|
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| {|
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| |-
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| | valign=top |
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| {| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:48em" cellpadding="0" cellspacing="0";
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| ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Native valve}}''
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| |-
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| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
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| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin sulbactam|Ampicillin-Sulbactam]] 3 g q6h IV x 4–6 wks'''''<BR>''PLUS''<BR> ▸ '''''[[Gentamicin|Gentamicin sulfate]] 1 mg per kg q8h IV/IM x 4–6 wks'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''OR''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Vancomycin]] 15 mg per kg q12h IV x 4–6 wks''''' <BR>''PLUS''<BR>▸ '''''[[Gentamicin|Gentamicin sulfate]] 1 mg per kg q8h IV/IM x 4–6 wks''''' <BR>''PLUS''<BR>'''''[[Ciprofloxacin]] 500 mg q12h PO or 320 mg q12h IV x 4–6 wks'''''
| |
| |-
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| ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
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| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸'''''[[Ampicillin sulbactam|Ampicillin-Sulbactam]]300 mg per kg per 24 h IV in 4–6 equally divided doses'''''<BR>''PLUS''<BR> ▸'''''[[Gentamicin]] 1 mg per kg q8h IV/IM x 4–6 wks'''''
| |
| |-
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''OR''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸'''''[[Vancomycin]] 32 mg per kg per 24 h in 2 or 3 equally divided doses x 4–6 wks'''''<BR>''PLUS''<BR>▸ '''''[[Gentamicin|Gentamicin sulfate]] 1 mg per kg q8h IV/IM x 4–6 wks'''''<BR>''PLUS''<BR> ▸'''''[[Ciprofloxacin]] 10-15 mg per kg q12h IV/PO x 4–6 wks'''''
| |
| |-
| |
| |}
| |
| |}
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|
| |
| </div></div>
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|
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| <div class="mw-collapsible mw-collapsed">
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|
| |
| ===Prosthetic Valve Culture Negative Endocarditis===
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|
| |
| <div class="mw-collapsible-content">
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|
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| {|
| |
| |-
| |
| | valign=top |
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| {| style="margin: 0 0 0em 0em; border: 1px solid #696969; float:left; width:48em" cellpadding="0" cellspacing="0";
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| ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Prosthetic valve (early, ≤ 1y)}}''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg per kg q12h IV x 4-6 wks'''''<BR>''PLUS''<BR>▸ '''''[[Gentamicin|Gentamicin sulfate]] 1 mg per kg q8h IV/IM x 2wks'''''<BR>''PLUS''<BR>▸'''''[[Cefepime]] 2 g q8h IV x 6 wks''''' <BR>''PLUS''<BR>▸ '''''[[Rifampin]] 300 mg q8h PO/IV x 6 wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatric dose}}''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸'''''[[Vancomycin]] 15 mg per kg q12h IV x 4-6 wks'''''<BR>''PLUS''<BR> ▸'''''[[Gentamicin]] 1 mg per kg q8h IV/IM x 2 wks'''''<BR>''PLUS''<BR> ▸'''''[[Cefepime]] 50 mg q8h IV x 6 wks '''''<BR>''PLUS''<BR> ▸'''''[[Rifampin]] 20 mg per kg per 24 h PO/IV in 3 equally divided doses x 6 wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Prosthetic valve (late—greater than 1 y) (same regimens as for native valve endocarditis with addition of [[rifampin]])}}''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin sulbactam|Ampicillin-Sulbactam]] 3 g q6h IV x 4–6 wks'''''<BR>''PLUS''<BR>▸ '''''[[Gentamicin|Gentamicin sulfate]] 1 mg per kg q8h IV/IM x 4–6 wks'''''<BR>''PLUS''<BR>▸ '''''[[Rifampin]] 300 mg q8h PO/IV x 6 wks'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''OR''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg per kg q12h IV x 4–6 wks'''''<BR>''PLUS''<BR>▸ '''''[[Gentamicin|Gentamicin sulfate]] 1 mg per kg q8h IV/IM x 4–6 wks'''''<BR>''PLUS''<BR>▸ '''''[[Ciprofloxacin]] 500 mg q12h PO or 320 mg q12h IV x 4–6 wks'''''<BR>''PLUS''<BR>▸ '''''[[Rifampin]] 300 mg q8h PO/IV x 6 wks'''''
| |
| |-
| |
| |}
| |
| |}
| |
|
| |
| </div></div>
| |
|
| |
| <div class="mw-collapsible mw-collapsed">
| |
|
| |
| ===Bartonella Culture Negative Endocarditis===
| |
|
| |
| <div class="mw-collapsible-content">
| |
|
| |
| {|
| |
| |-
| |
| | valign=top |
| |
| {| style="margin: 0 0 0em 0em; border: 1px solid #696969; float:left; width:48em" cellpadding="0" cellspacing="0";
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| ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Suspected Bartonella, (culture negative)}}''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone sodium]] 2 g per 24 h IV/IM in 1 dose x 6 wks'''''<BR>''PLUS''<BR>▸ '''''[[Gentamicin|Gentamicin sulfate]] 1 mg per kg q8h IV/IM x 2 wks'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |''WITH / WITHOUT''
| |
| |-
| |
| |style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] 100 mg per kg q12h IV/PO x 6 wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatrics dose}}''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone sodium]] 100 mg/kg per 24 h IV/IM once daily x 6 wks''''' <BR>''PLUS''<BR> ▸ '''''[[Gentamicin|Gentamicin sulfate]] 1 mg per kg q8h IV/IM x 2 wks'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |''WITH / WITHOUT''
| |
| |-
| |
| |style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] 2–4 mg per kg per 24 h IV/PO in 2 equally divided doses'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Documented Bartonella, (culture positive)}}''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult dose}}''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] 100 mg q12h IV or PO x 6 wks'''''<BR>''PLUS''<BR>▸ '''''[[Gentamicin|Gentamicin sulfate]] 1 mg per kg q8h IV/IM x 2 wks'''''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pediatrics dose}}''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸'''''[[Doxycycline]] 2–4 mg per kg per 24 h IV/PO in 2 equally divided doses'''''<BR>''PLUS''<BR>▸'''''[[Gentamicin]] 1 mg per kg q8h IV/IM'''''
| |
| |-
| |
| |}
| |
| |}
| |
|
| |
| </div></div>
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|
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|
| ==References== | | ==References== |
| Line 875: |
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| [[Category:Intensive care medicine]] | | [[Category:Intensive care medicine]] |
| [[Category:Up-To-Date]] | | [[Category:Up-To-Date]] |
|
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| {{WH}}
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| {{WS}}
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