Mediastinitis medical therapy: Difference between revisions
Jump to navigation
Jump to search
Sergekorjian (talk | contribs) |
|||
| Line 7: | Line 7: | ||
==Medical Therapy== | ==Medical Therapy== | ||
===Antimicrobial Regimen=== | ===Antimicrobial Regimen=== | ||
*''' | * '''1. Post-cardiothoracic surgery mediastinitis'''<ref name="pmid22070836">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 24 | pages= e123-210 | pmid=22070836 | doi=10.1016/j.jacc.2011.08.009 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22070836 }} </ref> | ||
:* '''Treatment | :* '''1.1 Treatment''' | ||
::* Preferred regimen: [[Clindamycin]] 450 mg IV q6h {{and}} [[Ceftriaxone]] 2 g IV q24h, for at least 2 weeks | ::* Preferred regimen: [[Clindamycin]] 450 mg IV q6h {{and}} [[Ceftriaxone]] 2 g IV q24h, for at least 2 weeks | ||
:* '''Prophylaxis''' | :::* Note: A deep sternal wound [[infection]] should be treated with aggressive surgical [[debridement]] in the absence of complicating circumstances. | ||
::* '''Methicillin susceptible staphylococcus aureus infection''' | :* '''1.2 Prophylaxis''' | ||
:::* Preferred regimen: Second generation [[cephalosporin]] | ::* '''1.2.1 Methicillin susceptible staphylococcus aureus infection''' | ||
::* '''Methicillin susceptible staphylococcus aureus infection''' | :::* Preferred regimen: Second generation [[cephalosporin]] | ||
::* '''1.2.2 Methicillin susceptible staphylococcus aureus infection''' | |||
:::* Preferred regimen: [[Vancomycin]] | :::* Preferred regimen: [[Vancomycin]] | ||
:::* Note (1): Preoperative [[antibiotics]] should be administered to all patients to reduce the risk of [[mediastinitis]] in cardiac surgery. | :::* Note (1): Preoperative [[antibiotics]] should be administered to all patients to reduce the risk of [[mediastinitis]] in cardiac surgery. | ||
:::* Note (2 | :::* Note (2): The use of intranasal [[mupirocin]] is reasonable in nasal carriers of [[S. aureus]]. | ||
* '''2. Descending necrotizing mediastinitis''' | |||
==References== | ==References== | ||
Revision as of 14:45, 18 August 2015
|
Mediastinitis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Mediastinitis medical therapy On the Web |
|
American Roentgen Ray Society Images of Mediastinitis medical therapy |
|
Risk calculators and risk factors for Mediastinitis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The mainstay of therapy in acute mediastinitis includes Clindamycin and Ceftriaxone. The preferred regimen for prophylaxis against acute mediastinitis includes either Vancomycin or a second generation Cephalosporin.
Medical Therapy
Antimicrobial Regimen
- 1. Post-cardiothoracic surgery mediastinitis[1]
- 1.1 Treatment
- Preferred regimen: Clindamycin 450 mg IV q6h AND Ceftriaxone 2 g IV q24h, for at least 2 weeks
- Note: A deep sternal wound infection should be treated with aggressive surgical debridement in the absence of complicating circumstances.
- 1.2 Prophylaxis
- 1.2.1 Methicillin susceptible staphylococcus aureus infection
- Preferred regimen: Second generation cephalosporin
- 1.2.2 Methicillin susceptible staphylococcus aureus infection
- Preferred regimen: Vancomycin
- Note (1): Preoperative antibiotics should be administered to all patients to reduce the risk of mediastinitis in cardiac surgery.
- Note (2): The use of intranasal mupirocin is reasonable in nasal carriers of S. aureus.
- 2. Descending necrotizing mediastinitis
References
- ↑ Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons". J Am Coll Cardiol. 58 (24): e123–210. doi:10.1016/j.jacc.2011.08.009. PMID 22070836.