Sandbox-ID-Cardiovascular

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Cardiovascular

Aortitis, infectious ⇧ Return to Top ⇧
Cardiovascular implantable electronic device infections ⇧ Return to Top ⇧

Endocarditis

Endocarditis, prophylaxis ⇧ Return to Top ⇧
Endocarditis, treatment ⇧ Return to Top ⇧
  • Infective endocarditis[1]
  • Culture-negative endocarditis
  • Culture-negative, native valve endocarditis
  • Culture-negative, prosthetic valve endocarditis (early, ≤ 1 year)
  • Culture-negative, prosthetic valve endocarditis (late, > 1 year)
  • Culture-negative, prosthetic valve endocarditis (early, ≤ 1 year)
  • Pathogen-directed antimicrobial therapy
  • Bartonella
  • Suspected Bartonella endocarditis
  • Documented Bartonella endocarditis
  • Enterococcus
  • Endocarditis caused by enterococcal strains susceptible to penicillin, gentamicin, and vancomycin
  • Preferred regimen : Ampicillin 12 g/24h IV q4h for 4–6 weeks OR Penicillin G 18–30 million U/24h IV either continuously or q4h for 4–6 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 4–6weeks
  • Alternative regimen : Vancomycin 30 mg/kg/24h IV q12h for 6 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 6 weeks
  • Pediatric dose: Vancomycin 40 mg/kg/24h IV q8–12h; Gentamicin 3 mg/kg/24h IV/IM q8h
  • Endocarditis caused by enterococcal strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin
  • Endocarditis caused by enterococcal strains resistant to penicillin and susceptible to aminoglycoside and vancomycin
  • β-Lactamase–producing strain
  • Intrinsic penicillin resistance
  • Endocarditis caused by enterococcal strains resistant to penicillin, gentamicin, and vancomycin
  • Enterococcus faecium
  • Enterococcus faecalis
  • HACEK organisms
  • Endocarditis caused by Haemophilus, Aggregatibacter (Actinobacillus), Cardiobacterium, Eikenella corrodens, or Kingella
  • Staphylococcus
  • Native valve endocarditis caused by oxacillin-susceptible staphylococci
  • Native valve endocarditis caused by oxacillin-resistant staphylococci
  • Preferred regimen: Vancomycin 30 mg/kg/24h IV q12h for 6 weeks
  • Pediatric dose: Vancomycin 40 mg/kg/24h IV q8–12h
  • Prosthetic valve endocarditis caused by oxacillin-susceptible staphylococci
  • Prosthetic valve endocarditis caused by oxacillin-resistant staphylococci
  • Preferred regimen: Vancomycin 30 mg/kg 24 h q12h for ≥ 6 weeks AND Rifampin 900 mg/24h IV/PO q8h for ≥ 6 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8–12h for 2 weeks
  • Pediatric dose: Vancomycin 40 mg/kg/24h IV q8–12h; Rifampin 20 mg/kg/24h IV/PO q8h (up to adult dose); Gentamicin 3 mg/kg/24h IV or IM q8h
  • Viridans group streptococci and Streptococcus bovis
  • Native valve endocarditis caused by highly penicillin-susceptible viridans group streptococci and Streptococcus bovis (MIC ≤ 0.12 μg/mL)
  • Preferred regimen: Penicillin G 12–18 million U/24h IV either continuously or q4–6h for 4 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 4 weeks
  • Alternative regimen (1): (Penicillin G 12–18 million U/24h IV either continuously or q4h for 2 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 2 weeks) AND Gentamicin 3 mg/kg/24h IV/IM in 1 dose for 2 weeks
  • Alternative regimen (2): Vancomycin 30 mg/kg/24h IV q12h not to exceed 2 g/24h for 4 weeks
  • Pediatric dose: Penicillin G 200,000 U/kg/24h IV q4–6h; Ceftriaxone 100 mg/kg/24h IV/IM in 1 dose; Gentamicin 3 mg/kg/24h IV/IM in 1 dose or q8h; Vancomycin 40 mg/kg/24h IV q8–12h
  • Native valve endocarditis caused by relatively penicillin-resistant viridans group streptococci and Streptococcus bovis (MIC > 0.12 to ≤ 0.5 μg/mL)
  • Preferred regimen (1): (Penicillin G 24 million U/24h IV either continuously or q4–6h for 4 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 4 weeks) AND Gentamicin 3 mg/kg/24h IV/IM in 1 dose for 2 weeks
  • Preferred regimen (2): Vancomycin 30 mg/kg/24h IV q12h not to exceed 2 g/24h for 4 weeks
  • Pediatric dose: Penicillin G 200,000 U/kg/24h IV q4–6h; Ceftriaxone 100 mg/kg/24h IV/IM in 1 dose; Gentamicin 3 mg/kg/24h IV/IM in 1 dose or q8h; Vancomycin 40 mg/kg/24h IV q8–12h
  • Prosthetic valve endocarditis caused by highly penicillin-susceptible viridans group streptococci and Streptococcus bovis (MIC ≤ 0.12 μg/mL)
  • Preferred regimen (1): (Penicillin G 24 million U/24h IV either continuously or q4–6h for 6 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 6 weeks) ± Gentamicin 3 mg/kg/24h IV/IM in 1 dose for 2 weeks
  • Preferred regimen (2): Vancomycin 30 mg/kg/24h IV q12h not to exceed 2 g/24h for 6 weeks
  • Pediatric dose: Penicillin G 200,000 U/kg/24h IV q4–6h; Ceftriaxone 100 mg/kg/24h IV/IM in 1 dose; Gentamicin 3 mg/kg/24h IV/IM in 1 dose or q8h; Vancomycin 40 mg/kg/24h IV q8–12h
  • Prosthetic valve endocarditis caused by relatively penicillin-resistant viridans group streptococci and Streptococcus bovis (MIC > 0.12 μg/mL)
  • Preferred regimen (1): (Penicillin G 24 million U/24h IV either continuously or q4–6h for 6 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 6 weeks) AND Gentamicin 3 mg/kg/24h IV/IM in 1 dose for 2 weeks
  • Preferred regimen (2): Vancomycin 30 mg/kg/24h IV q12h not to exceed 2 g/24h for 6 weeks
  • Pediatric dose: Penicillin G 200,000 U/kg/24h IV q4–6h; Ceftriaxone 100 mg/kg/24h IV/IM in 1 dose; Gentamicin 3 mg/kg/24h IV/IM in 1 dose or q8h; Vancomycin 40 mg/kg/24h IV q8–12h
Intravascular catheter-related infections ⇧ Return to Top ⇧
Mediastinitis, acute ⇧ Return to Top ⇧

Mycotic aneurysm ⇧ Return to Top ⇧

  • Empiric antimicrobial therapy[2]

Myocarditis

Lyme carditis ⇧ Return to Top ⇧
  • Lyme carditis, adult[3]
  • Parenteral regimen
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (14–21) days
  • Alternative regimen: Cefotaxime 2 g IV q8h for 14 (14–21) days OR Penicillin G 18–24 million U/day IV q4h for 14 (14–21) days
  • Oral regimen
  • Preferred regimen: Amoxicillin 500 mg tid for 14 (14–21) days OR Doxycycline 100 mg bid for 14 (14–21) days OR Cefuroxime 500 mg bid for 14 (14–21) days
  • Alternative regimen: Azithromycin 500 mg PO qd for 7–10 days OR Clarithromycin 500 mg PO bid for 14–21 days (if the patient is not pregnant) OR Erythromycin 500 mg PO qid for 14–21 days
Note (1): Parenteral regimen is recommended at the start of therapy for patients who have been hospitalized for cardiac monitoring; oral regimen may be substituted to complete a course of therapy or to treat ambulatory patients.
Note (2): A temporary pacemaker may be required for patients with advanced heart block.
Note (3): Patients treated with macrolides should be closely observed to ensure resolution of the clinical manifestations.
  • Lyme carditis, pediatric[4]
  • Parenteral regimen
  • Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (maximum, 2 g) for 14 (14–21) days
  • Alternative regimen: Cefotaxime 150–200 mg/kg/day IV q6–8h (maximum, 6 g per day) for 14 (14–21) days OR Penicillin G 200,000–400,000 U/kg/day IV q4h (not to exceed 18–24 million U per day) for 14 (14–21) days
  • Oral regimen
  • Preferred regimen: Amoxicillin 50 mg/kg/day PO tid (maximum, 500 mg per dose) for 14 (14–21) days OR Doxycycline (for children aged ≥ 􏱢8 years) 4 mg/kg/day PO bid (maximum, 100 mg per dose) for 14 (14–21) days OR Cefuroxime 30 mg/kg/day PO bid (maximum, 500 mg per dose) for 14 (14–21) days
  • Alternative regimen: Azithromycin 10 mg/kg/day (maximum of 500 mg per day) for 7–10 days OR Clarithromycin 7.5 mg/kg PO bid (maximum of 500 mg per dose) for 14–21 days OR Erythromycin 12.5 mg/kg PO qid (maximum of 500 mg per dose) for 14–21 days
Note (1): Parenteral regimen is recommended at the start of therapy for patients who have been hospitalized for cardiac monitoring; oral regimen may be substituted to complete a course of therapy or to treat ambulatory patients.
Note (2): A temporary pacemaker may be required for patients with advanced heart block.
Note (3): Patients treated with macrolides should be closely observed to ensure resolution of the clinical manifestations.
Myocarditis, viral ⇧ Return to Top ⇧

Pericarditis

Pericarditis, bacterial ⇧ Return to Top ⇧
  • Bacterial pericarditis
  • Empiric antimicrobial therapy[5][6]
  • Preferred regimen: Vancomycin 1 g IV q12h targeting trough levels of 15–20 μg/mL for 28 days AND Ciprofloxacin 400 mg IV q12h for 28 days
  • Alternative regimen (1): Vancomycin 1 g IV q12h targeting trough levels of 15–20 μg/mL for 28 days AND Cefepime 2 g IV q12h for 28 days
  • Alternative regimen (2): Vancomycin 1 g IV q12h targeting trough levels of 15–20 μg/mL for 14–42 days AND Ceftriaxone 2 g IV q24h for 14–42 days
Note: Pericardiocentesis must be promptly performed. Pericardial drainage combined with effective systemic antibiotic therapy is mandatory (antistaphylococcal agent plus aminoglycoside, followed by tailored antibiotic therapy according to cultures). Frequent irrigation of the pericardial cavity with urokinase or streptokinase may be considered. Open surgical drainage through subxiphoid pericardiotomy is preferable. Pericardiectomy may be required in patients with dense adhesions, loculated and thick purulent effusion, recurrence of tamponade, persistent infection, and progression to constriction.
  • Purulent pericarditis with contiguous pneumonia
  • Purulent pericarditis with contiguous head and neck infection
  • Purulent pericarditis secondary to infective endocarditis
  • Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h targeting trough levels of 15–20 μg/mL AND Gentamicin 3 mg/kg/day IV q8–12h
  • Purulent pericarditis after cardiac surgery, pediatric
  • Preferred regimen: Vancomycin 15 mg/kg IV q6h targeting trough levels of 15–20 μg/mL AND (Ceftriaxone 100 mg/kg/day IV q12–24h OR Cefotaxime 200–300 mg/kg/day IV q6–8h) AND Gentamicin 6–7.5 mg/kg/day IV q8h
  • Purulent pericarditis with genitourinary infection, pediatric
  • Preferred regimen: Vancomycin 15 mg/kg IV q6h targeting trough levels of 15–20 μg/mL AND (Ceftriaxone 100 mg/kg/day IV q12–24h OR Cefotaxime 200–300 mg/kg/day IV q6–8h) AND Gentamicin 6–7.5 mg/kg/day IV q8h
  • Purulent pericarditis in immunocompromised host, pediatric
  • Preferred regimen: Vancomycin 15 mg/kg IV q6h targeting trough levels of 15–20 μg/mL AND (Ceftriaxone 100 mg/kg/day IV q12–24h OR Cefotaxime 200–300 mg/kg/day IV q6–8h) AND Gentamicin 6–7.5 mg/kg/day IV q8h
  • Pathogen-directed antimicrobial therapy[11]
  • Anaerobes
  • Gram-negative bacilli
  • Legionella pneumophila
  • Mycoplasma pneumoniae
  • Neisseria meningitidis
  • Preferred regimen: Penicillin G 5–24 MU/day IM/IV q4–6h for 14–42 days OR Cefotaxime 2 g IV q6–8h for 14–42 days OR Ceftriaxone 2 g IV q24h for 14–42 days
  • Staphylococcus aureus, methicillin-susceptible
  • Preferred regimen: Nafcillin 1–2 g IV q4h for 14–42 days OR Oxacillin 1–2 g IV q4h for 14–42 days OR Cefazolin 1–2 g IV q48h for 14–42 days OR Vancomycin 1 g IV q12h targeting trough levels of 15–20 μg/mL for 14–42 days OR Clindamycin 600–900 mg IV q8h for 14–42 days
  • Staphylococcus aureus, methicillin-resistant
  • Preferred regimen: Vancomycin 1 g IV q12h targeting trough levels of 15–20 μg/mL for 14–42 days OR Linezolid 600 mg IV q12h for 14–42 days
  • Streptococcus pneumoniae, penicillin-susceptible
  • Streptococcus pneumoniae, penicillin-resistant
  • Preferred regimen: Ciprofloxacin 400 mg IV q12h for 14–42 days OR Levofloxacin 500–750 mg IV q24h for 14–42 days OR Vancomycin 1 g IV q12h targeting trough levels of 15–20 μg/mL for 14–42 days
Pericarditis, fungal ⇧ Return to Top ⇧
Pericarditis, tuberculous ⇧ Return to Top ⇧
Pericarditis, viral ⇧ Return to Top ⇧

Rheumatic fever

Rheumatic fever, primary prophylaxis ⇧ Return to Top ⇧
Rheumatic fever, secondary prophylaxis ⇧ Return to Top ⇧
Septic pelvic vein thrombophlebitis ⇧ Return to Top ⇧
  1. ↑ Baddour, Larry M.; Wilson, Walter R.; Bayer, Arnold S.; Fowler, Vance G.; 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.; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease; Council on Cardiovascular Disease in the Young; Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia; American Heart Association; Infectious Diseases Society of America (2005-06-14). "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): –394-434. doi:10.1161/CIRCULATIONAHA.105.165564. ISSN 1524-4539. PMID 15956145.
  2. ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
  3. ↑ Wormser, Gary P.; Dattwyler, Raymond J.; Shapiro, Eugene D.; Halperin, John J.; Steere, Allen C.; Klempner, Mark S.; Krause, Peter J.; Bakken, Johan S.; Strle, Franc; Stanek, Gerold; Bockenstedt, Linda; Fish, Durland; Dumler, J. Stephen; Nadelman, Robert B. (2006-11-01). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 43 (9): 1089–1134. doi:10.1086/508667. ISSN 1537-6591. PMID 17029130.
  4. ↑ Wormser, Gary P.; Dattwyler, Raymond J.; Shapiro, Eugene D.; Halperin, John J.; Steere, Allen C.; Klempner, Mark S.; Krause, Peter J.; Bakken, Johan S.; Strle, Franc; Stanek, Gerold; Bockenstedt, Linda; Fish, Durland; Dumler, J. Stephen; Nadelman, Robert B. (2006-11-01). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 43 (9): 1089–1134. doi:10.1086/508667. ISSN 1537-6591. PMID 17029130.
  5. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  6. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  7. ↑ Maisch, Bernhard; Seferović, Petar M.; Ristić, Arsen D.; Erbel, Raimund; Rienmüller, Reiner; Adler, Yehuda; Tomkowski, Witold Z.; Thiene, Gaetano; Yacoub, Magdi H.; Task Force on the Diagnosis and Management of Pricardial Diseases of the European Society of Cardiology (2004-04). "Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology". European Heart Journal. 25 (7): 587–610. doi:10.1016/j.ehj.2004.02.002. ISSN 0195-668X. PMID 15120056. Check date values in: |date= (help)
  8. ↑ Pankuweit, Sabine; Ristić, Arsen D.; Seferović, Petar M.; Maisch, Bernhard (2005). "Bacterial pericarditis: diagnosis and management". American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions. 5 (2): 103–112. ISSN 1175-3277. PMID 15725041.
  9. ↑ Goodman, null (2000-08). "Purulent Pericarditis". Current Treatment Options in Cardiovascular Medicine. 2 (4): 343–350. ISSN 1092-8464. PMID 11096539. Check date values in: |date= (help)
  10. ↑ Cherry, James (2014). Feigin and Cherry's textbook of pediatric infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455711772.
  11. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
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