Sandbox endocarditis: Difference between revisions
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| '''Ciprofloxacin'''||1000 mg per 24 h PO or 800 mg per 24 h IV in 2 equally divided doses||4–6 | | '''Ciprofloxacin'''||1000 mg per 24 h PO or 800 mg per 24 h IV in 2 equally divided doses||4–6 | ||
|- | |- | ||
| ||Pediatric | | ||Pediatric dose: | ||
*'''Ampicillin-sulbactam''' 300 mg per kg per 24 h IV in 4–6 equally divided doses | *'''Ampicillin-sulbactam''' 300 mg per kg per 24 h IV in 4–6 equally divided doses | ||
*'''Gentamicin''' 3 mg per kg per 24 h IV/IM in 3 equally divided doses | *'''Gentamicin''' 3 mg per kg per 24 h IV/IM in 3 equally divided doses | ||
*'''Vancomycin''' 40 mg per kg per 24 h in 2 or 3 equally divided doses | *'''Vancomycin''' 40 mg per kg per 24 h in 2 or 3 equally divided doses | ||
*'''Ciprofloxacin''' 20–30 mg per kg per 24 h IV/PO in 2 equally divided doses | *'''Ciprofloxacin''' 20–30 mg per kg per 24 h IV/PO in 2 equally divided doses | ||
|- | |||
| ||'''''Prosthetic valve (early, ≤ 1y)'''''|| | |||
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Revision as of 03:16, 14 January 2014
| Regimen | Dosage and Route | Duration(wk) | |
|---|---|---|---|
| Native valve | |||
| Ampicillin-sulbactam | 12 g per 24 h IV in 4 equally divided doses | 4–6 | |
| plus | |||
| Gentamicin sulfate | 3 mg per kg per 24 h IV/IM in 3 equally divided doses | 4–6 | |
| or | |||
| Vancomycin | 30 mg per kg per 24 h IV in 2 equally divided doses | 4–6 | |
| plus | |||
| Gentamicin sulfate | 3 mg per kg per 24 h IV/IM in 3 equally divided doses | 4–6 | |
| plus | |||
| Ciprofloxacin | 1000 mg per 24 h PO or 800 mg per 24 h IV in 2 equally divided doses | 4–6 | |
Pediatric dose:
| |||
| Prosthetic valve (early, ≤ 1y) |
Empirical Antibiotic Therapy
- Although antibiotic therapy for subacute disease can be delayed till the result of blood culture, the delay in laboratory-based diagnostic techniques to detect the causing pathogens, beside bacterial endocarditis rapid progression necessitate that empirical treatment antibiotic therapy should be started once the blood culture have been collected
- Empirical therapy is needed for all likely pathogens, certain antibiotic agents, including aminoglycosides, is preferably avoided for its toxic effects.
- Clinical course of infection beside the epidemiological features should be considered upon selecting empirical treatment regimen.
Treatment Based Upon Infectious Agent[1]
Penicillin-Susceptible Strep Viridans and Other Nonenterococcal Streptococci
Penicillin G
- If Minimum inhibitory concentration [MIC] <0.2 µg/ml.
- Dose: 12–18 million units I.V. daily in divided doses q. 4 hour for 4 weeks.
Penicillin G + Gentamicin
- Dose: Penicillin G, 12–18 million units I.V. daily in divided doses q. 4 hour for 4 weeks plus gentamicin, 3 mg/kg I.M. or I.V. daily in divided doses q. 8 hour for 2 weeks (peak serum concentration should be ~ 3 µg/ml and trough concentrations < 1 µg/ml).
Ceftriaxone
- Dose: 2 g I.V. daily as a single dose for 2 weeks.
References
- ↑ 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. (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-Executive Summary: Endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): 3167–84. PMID 15956145.