Sandbox/002: Difference between revisions
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! style="height: 30px; 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|Enterococcal Endocarditis, VM/AG Susceptible, PCN Resistant, Adult}} | ! style="height: 30px; 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|Enterococcal Endocarditis, VM/AG Susceptible, PCN Resistant, Adult}} | ||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen <BR> β-Lactamase–Producing Strain'''''<sup>†</sup> | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin/Sulbactam]] 3 g IV q6h x 6 weeks''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin/Sulbactam]] 3 g IV q6h x 6 weeks''''' | ||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1 mg/kg IV/IM q8h x 6 weeks'''''<sup>¶</sup> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1 mg/kg IV/IM q8h x 6 weeks'''''<sup>¶</sup> | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen <BR> β-Lactamase–Producing Strain''''' | ||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q12h x 6 weeks'''''<sup>ǁ</sup> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q12h x 6 weeks'''''<sup>ǁ</sup> | ||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1 mg/kg IV/IM q8h x 6 weeks'''''<sup>¶</sup> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1 mg/kg IV/IM q8h x 6 weeks'''''<sup>¶</sup> | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen <BR> Intrinsic Penicillin Resistance'''''<sup>‡</sup> | ||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q12h x 6 weeks'''''<sup>ǁ</sup> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q12h x 6 weeks'''''<sup>ǁ</sup> | ||
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| style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>†</sup> Unlikely that the strain will be susceptible to gentamicin; if strain is gentamicin resistant, then >6 wk of ampicillin-sulbactam therapy will be needed. <BR> <sup>¶</sup> Gentamicin dosage should be adjusted to achieve peak serum concentration of 3—4 μg/ml and trough serum concentration of less than 1 μg/ml when 3 divided doses are used; nomogram used for single daily dosing; other potentially nephrotoxic drugs (e.g., nonsteroidal anti-inflammatory drugs) should be used with caution in patients receiving gentamicin therapy. <BR> <sup>ǁ</sup> Vancomycin therapy recommended only for patients unable to tolerate ampicillin-sulbactam. Vancomycin doses should not exceed 2 g per 24 h, unless serum concentrations are inappropriately low. 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. Vancomycin should be infused during course of at least 1 h to reduce risk of histamine-release red man syndrome. <BR> <sup>‡</sup> Consultation with a specialist in infectious diseases recommended. | | style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>†</sup> Unlikely that the strain will be susceptible to gentamicin; if strain is gentamicin resistant, then >6 wk of ampicillin-sulbactam therapy will be needed. <BR> <sup>¶</sup> Gentamicin dosage should be adjusted to achieve peak serum concentration of 3—4 μg/ml and trough serum concentration of less than 1 μg/ml when 3 divided doses are used; nomogram used for single daily dosing; other potentially nephrotoxic drugs (e.g., nonsteroidal anti-inflammatory drugs) should be used with caution in patients receiving gentamicin therapy. <BR> <sup>ǁ</sup> Vancomycin therapy recommended only for patients unable to tolerate ampicillin-sulbactam. Vancomycin doses should not exceed 2 g per 24 h, unless serum concentrations are inappropriately low. 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. Vancomycin should be infused during course of at least 1 h to reduce risk of histamine-release red man syndrome. <BR> <sup>‡</sup> Consultation with a specialist in infectious diseases recommended. | ||
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{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table28" style="background: #FFFFFF;" | |||
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{| style="float: left; cellpadding=0; cellspacing= 0; width: 600px;" | |||
! style="height: 30px; 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|Enterococcal Endocarditis, VM/AG Susceptible, PCN Resistant, Pediatric}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen <BR> β-Lactamase–Producing Strain'''''<sup>†</sup> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin/Sulbactam]] 75 mg/kg IV q6h x 6 weeks''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1 mg/kg IV/IM q8h x 6 weeks'''''<sup>¶</sup> | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen <BR> β-Lactamase–Producing Strain''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 40 mg/kg/day IV q8—12h x 6 weeks'''''<sup>ǁ</sup> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1 mg/kg IV/IM q8h x 6 weeks'''''<sup>¶</sup> | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen <BR> Intrinsic Penicillin Resistance'''''<sup>‡</sup> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 40 mg/kg/day IV q8—12h x 6 weeks'''''<sup>ǁ</sup> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1 mg/kg IV/IM q8h x 6 weeks'''''<sup>¶</sup> | |||
|- | |||
| style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>†</sup> Unlikely that the strain will be susceptible to gentamicin; if strain is gentamicin resistant, then >6 wk of ampicillin-sulbactam therapy will be needed. <BR> <sup>¶</sup> Gentamicin dosage should be adjusted to achieve peak serum concentration of 3—4 μg/ml and trough serum concentration of less than 1 μg/ml when 3 divided doses are used; nomogram used for single daily dosing; other potentially nephrotoxic drugs (e.g., nonsteroidal anti-inflammatory drugs) should be used with caution in patients receiving gentamicin therapy. <BR> <sup>ǁ</sup> Vancomycin therapy recommended only for patients unable to tolerate ampicillin-sulbactam. Vancomycin doses should not exceed 2 g per 24 h, unless serum concentrations are inappropriately low. 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. Vancomycin should be infused during course of at least 1 h to reduce risk of histamine-release red man syndrome. <BR> <sup>‡</sup> Consultation with a specialist in infectious diseases recommended. | |||
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Revision as of 03:23, 7 March 2014
Endocarditis Microchapters |
Diagnosis |
---|
Treatment |
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease |
Case Studies |
Sandbox/002 On the Web |
Pathogen-Based Therapy Adapted from Circulation 2005;111(23):e394-434.[1] and Circulation 2008;118(15):e523-661.[2]
Viridans Streptococci or Streptococcus bovis
▸ Click on the following categories to expand treatment regimens.
Native Valve Endocarditis ▸ Highly PCN Susceptible, Adult ▸ Highly PCN Susceptible, Pediatric ▸ Relatively PCN Resistant, Adult ▸ Relatively PCN Resistant, Pediatric ▸ Highly PCN Resistant Prosthetic Valve Endocarditis ▸ PCN Susceptible, Adult ▸ PCN Susceptible, Pediatric ▸ PCN Resistant, Adult ▸ PCN Resistant, Pediatric |
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Streptococcus pneumoniae, Streptococcus pyogenes, and Groups B, C, and G Streptococci
▸ Click on the following categories to expand treatment regimens.
Streptococcus pneumoniae ▸ PCN Susceptible ▸ PCN Resistant, Without Meningitis ▸ PCN Resistant, With Meningitis Streptococcus pyogenes ▸ S. pyogenes Endocarditis Group B, C, and G Streptococcus ▸ Group B, C, and G Streptococcus Endocarditis |
|
Staphylococcus
▸ Click on the following categories to expand treatment regimens.
Native Valve Endocarditis ▸ Oxacillin Susceptible, Adult ▸ Oxacillin Susceptible, Pediatric ▸ Oxacillin Resistant, Adult ▸ Oxacillin Resistant, Pediatric Prosthetic Valve Endocarditis ▸ Oxacillin Susceptible, Adult ▸ Oxacillin Susceptible, Pediatric ▸ Oxacillin Resistant, Adult ▸ Oxacillin Resistant, Pediatric |
|
Enterococcus
▸ Click on the following categories to expand treatment regimens.
PCN/GM/VM Susceptible ▸ PCN/GM/VM Susceptible, Adult ▸ PCN/GM/VM Susceptible, Pediatric PCN/VM Susceptible, GM Resistant ▸ PCN/VM Susceptible, GM Resistant, Adult ▸ PCN/VM Susceptible, GM Resistant, Pediatric VM/AG Susceptible, PCN Resistant ▸ VM/AG Susceptible, PCN Resistant, Adult ▸ VM/AG Susceptible, PCN Resistant, Pediatric PCN/VM/AG Resistant ▸ PCN/VM/AG Resistant, Adult ▸ PCN/VM/AG Resistant, Pediatric |
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References
- ↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (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: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter
|month=
ignored (help) - ↑ Bonow, RO.; Carabello, BA.; Chatterjee, K.; de Leon, AC.; Faxon, DP.; Freed, MD.; Gaasch, WH.; Lytle, BW.; Nishimura, RA. (2008). "2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (13): e1–142. doi:10.1016/j.jacc.2008.05.007. PMID 18848134. Unknown parameter
|month=
ignored (help)