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====Gram-Negative Bacteria==== | |||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL> | |||
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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: 30px; line-height: 30px; width: 320px; background: #A1BCDD; text-align: center;"> | |||
<font color="#FFF"> | |||
'''Gram-Negative Bacteria''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table01" 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: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Bartonella''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table02" 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: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Escherichia coli''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table03" 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: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''HACEK Microorganisms''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table04" 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: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Klebsiella''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table05" 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: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Neisseria''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table06" 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: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Proteus mirabilis''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 5px 5px; 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: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Pseudomonas aeruginosa''''' | |||
</font> | |||
</div> | |||
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{| style="float: left; cellpadding=0; cellspacing= 0; width: 600px;" | {| 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| | ! 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|Bartonella}} | ||
|- | |- | ||
| style="font-size: 90% | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup> | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 12—18 MU/day IV continuously or q4—6h x 4 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV/IM q24h x 4 weeks''''' | ||
|- | |- | ||
| 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 1'''''<sup>‡</sup> | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 12—18 MU/day IV continuously or q4—6h x 2 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV/IM q24h x 2 weeks''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | | 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 | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg IV/IM q24h (or 1 mg/kg IV/IM q8h) x 2 weeks'''''<sup>¶</sup> | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | ''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 2''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q12h x | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q12h x 4 weeks'''''<sup>ǁ</sup> | ||
|- | |- | ||
| style=" | | style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>†</sup> Preferred in most patients greater than 65 y of age or patients with impairment of 8th cranial nerve function or renal function. <BR> <sup>‡</sup> Two-week regimen not intended for patients with known cardiac or extracardiac abscess or for those with creatinine clearance of less than 20 ml per min, impaired 8th cranial nerve function, or ''Abiotrophia'', ''Granulicatella'', or ''Gemella'' infection. <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> Recommended only for patients unable to tolerate penicillin or ceftriaxone. 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. | ||
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====Culture-Negative Endocarditis==== | |||
{| | |||
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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| | | valign=top | | ||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;" | |||
! 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|CNE adult}} | |||
|- | |- | ||
| 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'''''<sup>†</sup> | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 12—18 MU/day IV continuously or q4—6h x 4 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV/IM q24h x 4 weeks''''' | ||
|- | |- | ||
| style="font-size: 90% | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 1'''''<sup>‡</sup> | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 12—18 MU/day IV continuously or q4—6h x 2 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV/IM q24h x 2 weeks''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | | 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 | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg IV/IM q24h (or 1 mg/kg IV/IM q8h) x 2 weeks'''''<sup>¶</sup> | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | ''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 2''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q12h x 4 weeks'''''<sup>ǁ</sup> | ||
|- | |- | ||
| style=" | | style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>†</sup> Preferred in most patients greater than 65 y of age or patients with impairment of 8th cranial nerve function or renal function. <BR> <sup>‡</sup> Two-week regimen not intended for patients with known cardiac or extracardiac abscess or for those with creatinine clearance of less than 20 ml per min, impaired 8th cranial nerve function, or ''Abiotrophia'', ''Granulicatella'', or ''Gemella'' infection. <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> Recommended only for patients unable to tolerate penicillin or ceftriaxone. 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. | ||
|} | |} | ||
|} | |} | ||
| valign=top | | | valign=top | | ||
{| style="float: left; cellpadding=0; cellspacing= 0; width: | {| style="background: #FFFFFF;" | ||
! 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| | | valign=top | | ||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;" | |||
! 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|CNE pediatric}} | |||
|- | |- | ||
| 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''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg IV q24h''''' | ||
|- | |- | ||
| style="font-size: 90% | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 1''''' | ||
|- | |- | ||
| style=" | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 7 mg/kg IV q24h''''' ± '''''[[Ampicillin]] 500 mg IV q6h'''''<BR> OR <BR> ▸ '''''[[Tobramycin]] 7 mg/kg IV q24h''''' ± '''''[[Ampicillin]] 500 mg IV q6h'''''<BR> OR <BR> ▸ '''''[[Amikacin]] 20 mg/kg IV q24h''''' ± '''''[[Ampicillin]] 500 mg IV q6h''''' | ||
|- | |- | ||
| style="font-size: 90% | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 2''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1–2 gm IV q8h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 1 gm IV q24h'''''<BR> OR <BR> ▸ '''''[[Ceftazidime]] 2 gm IV q8h'''''<BR> OR <BR> ▸ '''''[[Ampicillin sulbactam|Ampicillin-Sulbactam]] 1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Piperacillin/Tazobactam|Piperacillin-Tazobactam]] 3.375 gm IV q4–6h'''''<BR> OR <BR> ▸ '''''[[Ticarcillin clavulanate|Ticarcillin-Clavulanate]] 3.1 gm IV q4–6h''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | WITH OR WITHOUT | ||
|- | |- | ||
| style=" | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 7 mg/kg IV q24h'''''<BR> OR <BR> ▸ '''''[[Tobramycin]] 7 mg/kg IV q24h'''''<BR> OR <BR> ▸ '''''[[Amikacin]] 20 mg/kg IV q24h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | ''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 3''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 500 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Ertapenem]] 1 g IV q24h'''''<BR> OR <BR> ▸ '''''[[Doripenem]] 500 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 1 g IV q8–12h | ||
|- | |- | ||
| style="font-size: 90% | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL> '''Antibiotics should be administered for at least 10–14 days based on local resistance patterns.''' <BR> '''De-escalation to oral antibiotcs may be considered 24–48 hours after defervescence.''' </SMALL> | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} |
Revision as of 04:42, 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 |
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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 |
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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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Gram-Negative Bacteria
▸ Click on the following categories to expand treatment regimens.
Gram-Negative Bacteria ▸ Bartonella ▸ Escherichia coli ▸ HACEK Microorganisms ▸ Klebsiella ▸ Neisseria ▸ Proteus mirabilis ▸ Pseudomonas aeruginosa |
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Culture-Negative Endocarditis
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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)