Sandbox ID Cardiovascular: Difference between revisions

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Aortitis, infectious

Preferred regimen^[1](1): Cefotaxime sodium 1.0 to 2.0 g IV qd
Preferred regimen (2): Ciprofloxacin hydrochloride 400 mg IV q12h OR Ciprofloxacin hydrochloride 500 to 750 mg PO q12h OR Levofloxacin 250 to 750 mg IV/PO qd
Preferred regimen (3): Oxacillin 1.0 to 2.0g IV or IM q4h / q6h OR Nafcillin 1.0 to 2.0 g IV or IM q4h / q6h OR Dicloxacillin 500 mg to 1.0 g IV or IM q4h /q6h
Preferred regimen (4): Vancomycin 1.0 g (15 mg/kg, up to 3.0 to 4.0 g/d) IV q12h
Note: Antimicrobial treatments are most effective when bactericidal, broadspectrum antibiotics are begun after obtaining blood cultures and prior to surgery. Dose of Cefotaxime sodium should be decreased by 50% in those with a creatinine clearance (CCr) of ≤ 20 mL/min. Ciprofloxacin should be used cautiously in those with a CCr ≤ 50 mL/min or when given concomitantly with drugs whose metabolism may be altered.

Cardiovascular implantable electronic device infections

1.1. Early post-implantation inflammation^[2]^[3]^[4]

Preferred regimen: Flucloxacillin 0.5–1 g PO tid

1.2. Penicillin allergy or MRSA Colonisation

Preferred regimen: Doxycycline 100 mg PO bid OR Linezolid 600 mg PO bid OR Clindamycin 450 mg po qid
Note: Benefit of and need for antimicrobial therapy in early post-implantation inflammation is unclear.

1.3. Early post-implantation inflammation in penicillin-allergic or MRSA-colonized patient

Preferred regimen: Doxycycline 100 mg PO bid OR Linezolid 600 mg PO bid OR Clindamycin 450 mg PO qid

1.4. Uncomplicated generator pocket infection

Preferred regimen: Vancomycin 1 g IV q12h OR Daptomycin 4 mg/kg IV qd OR Teicoplanin 6 mg/kg to a maximum of 1 g IV given at 0, 12 and 24 h and then qd

1.5. ICED-LI or ICED-IE or complicated generator pocket infection pending blood cultures, e.g. in severe sepsis

Preferred regimen: Vancomycin 1 g IV q12h AND Meropenem 1 g IV q8h OR Daptomycin 8–10 mg/kg IV qd AND Meropenem 1 g IV q8h
Note: Gentamicin or other anti-Gram-negative agents may be appropriate depending on local epidemiology.

1.6. ICED-LI or ICED-IE or generator pocket infection with negative blood cultures

Preferred regimen: Vancomycin 1 g IV q12h AND Gentamicin 1 mg/kg IV q12h OR Daptomycin 8–10 mg/kg IV qd AND Gentamicin 1 mg/kg IV q12h
Note: Duration of antimicrobial therapy should be at least 4 to 6 weeks for complicated infection (ie, endocarditis, septic thrombophlebitis, or osteomyelitis or if bloodstream infection persists despite device removal and appropriate initial antimicrobial therapy.

Intravascular catheter-related infections

1. Pathogen based treatment^[5]

1.1. Gram positive bacilli

1.1.1 Staphylococcus aureus

1.1.1.1. Methicillin susceptible

Preferred regimen: Naficillin 2 g IV q6h OR Oxacillin 2 g IV q6h
Alternative regimen: Cefazolin, 2 g IV q8h OR Vancomycin 15 mg/kg IV q12h
Pediatric doses:

Nafcillin

Neonates

0–4 weeks of age and 1200 g- 50 mg/kg/day in divided doses every 12 h
<=7 days and 1200–2000 g- 50 mg/kg/day in divided doses every 12 h
>7 days of age and <2000g- 75 mg/kg/day in divided doses every 8 h
>7 days of age and >1200 g - 100 mg/kg/day in divided doses every 6 h

Oxacillin

Neonates

0–4 weeks of age and 1200 g- 50 mg/kg/day in divided doses every 12 h
Postnatal age < 7 days and 1200–2000 g- 50–100 mg/kg/day in divided doses every 12 h
Postnatal age < 7 days and >2000 g, 75–150 mg/kg/day in divided doses every 8 h
Postnatal age >=7 days and 1200–2000 g- 75–150 mg/kg/day in divided doses every 8 h
Postnatal age >=7 days and >2000 g, 100–200 mg/kg/day in divided doses every 6 h

Infants and children Nafcillin 100–200 mg/kg/day in divided doses every 4–6 h

Cefazolin

Neonates

Postnatal age <=7 days: 40 mg/kg/day divided every 12 h
Postnatal age >7 days and 2000 g: 40 mg/kg/day divided every 12 h
Postnatal age >7 days and 12000 g: 60 mg/kg/day divided every 8 h

Infants and children: 50 mg/kg/day divided every 8 h

Vancomycin

Neonates

Postnatal age <=7 days and <1200 g, 15 mg/kg/day given every 24 h
Postnatal age <=7 days and 1200–2000 g, 10–15 mg/kg given every 12–18 h
Postnatal age <=7 days and >2000 g, 10–15 mg/kg given every 8–12 h
Postnatal age >7 days and <1200 g, 15 mg/kg/day given every 24 h
Postnatal age >7 days and 1200–2000 g, 10–15 mg/kg given every 8–12 h
Postnatal age >7 days and >2000 g, 15–20 mg/kg given every 8 h

Infants and children: 40 mg/kg/day in divided doses every 6–8 h

1.1.1.2. Methicillin resistant Staphylococcus aureus

Preferred regimen: (Vancomycin 15 mg/kg IV q12h OR Daptomycin 6–8 mg/kg per day IV, or Linezolid IV; OR Vancomycin IV) AND (Rifampicin IV OR Gentamycin IV OR TMP-SMZ IV alone) (if susceptible).
Pediatric dose

Linezolid

Neonates

0–4 weeks of age and birthweight <1200 g: 10 mg/kg every 8–12 h (note: use every 12 h in patients <34 weeks gestation and <1 week of age)
<7 days of age and birthweight >1200 g, 10 mg/kg every 8–12 h (note: use every 12 h in patients <34 weeks gestation and <1 week of age)
7 days and birthweight >1200 g, 10 mg/kg every 8 h

Infants and children <12 years of age: 10 mg/kg every 8 h Children 12 years of age and adolescents: 10 mg/kg every 12 h

Gentamycin

Neonates

Premature neonates and <1000 g, 3.5 mg/kg every 24 h; 0–4 weeks and <1200 g, 2.5 mg/kg every 18–24 h
Postnatal age 7 days: 2.5 mg/kg every 12 h
Postnatal age 17 days and 1200–2000 g, 2.5 mg/kg every 8–12 h
Postnatal age 17 days and 12000 g, 2.5 mg/kg every 8 h
Once daily dosing for premature neonates with normal renal function, 3.5–4 mg/kg every 24 h
Once daily dosing for term neonates with normal renal function, 3.5–5 mg/kg every 24 h

Infants and children <5 years of age: 2.5 mg/kg every 8 h; once daily dosing in patients with normal renal function, 5–7.5 mg/kg every 24 h
Children >5 years of age: 2–2.5 mg/kg every 8 h; once daily dosing in patients with normal renal function, 5–7.5 mg/kg every 24 h

TMP-SMZ

Infants 12 months of age and children: mild-to-moderate infections, 6–12 mg TMP/kg/day in divided doses every 12 h; serious infection, 15–20 mg TMP/kg/day in divided doses every 6–8 h

1.2. Coagulase-negative staphylococci

Methicillin susceptible

Preferred regimen: Naficillin 2 g IV q4h OR Oxacillin 2 g IV q4h
Alternative regimen: First-generation Cephalosporin OR Vancomycin OR TMP-SMZ

Methicillin resistant

Preferred regimen: Vancomycin 15 mg/kg IV q12h
Alternative regimen: Daptomycin 6 mg/kg per day IV OR linezolid IV

1.3. Enterococcus faecalis/Enterococcus faecium

Ampicillin susceptible

Preferred regimen: Ampicillin, 2 g IV q4h/ q6h;OR Ampicillin 1 mg/kg IV q8h OR Gentamycin 1 mg/kg IV q8h.
Alternative regimen: Vancomycin
Pediatric dose:

Ampicillin

Neonates

Postnatal age <=7 days and <=2000 g: 50 mg/kg/day divided every 12 h.
Postnatal age <=7 days and >2000 g, 75 mg/kg/day divided every 8 h.
Postnatal age >7 days and <1200 g, 50 mg/kg/day divided every 12 h.
Postnatal age >7 days and 1200–2000 g, 75 mg/kg/day divided every 8 h.
Postnatal age >7 days and >2000 g, 100 mg/kg/day divided every 6 h.

Infants and children: 100–200 mg/kg/day divided every 6 h 1

Ampicillin resistant, Vancomycin susceptible

Preferred regimen: Vancomycin, 15 mg/kg IV q12h ± Gentamycin, 1 mg/kg IV q8h.
Alternative regimen: Linezolid 6 mg/kg per day IV or Daptomycin 6 mg/kg per day IV.

Ampicillin resistant, Vancomycin resistant

Preferred regimen: Linezolid IV 600 mg q12h OR Daptomycin 6 mg/kg per day IV.
Alternative regimen: Quinupristin/Dalfopristin 7.5 mg/kg IV q8h.

1.4. Gram-negative bacilli

1.4.1. Escherichia coli and Klebsiella species

1.4.1.1. ESBL negative

Preferred regimen: Ceftriaxone 1–2 g per day IV.
Alternative regimen: Ciprofloxacin IV OR Aztreonam IV.
Pediatric dose:
Ceftriaxone

Neonates

Postnatal age <=7 days, 50 mg/kg/day given every 24 h.
Postnatal age >7 days and <=2000 g, 50 mg/kg/day given every 24 h.
Postnatal age >7 days and >2000 g, 50–75 mg/kg/day given every 24 h.

Infants and children: 50–75 mg/kg/day divided every 12–24 h.

Ciprofloxacin

Neonates: 7–40 mg/kg/day divided every 12 h.
Infants and children: 20–30 mg/kg/day divided every 12 h.

1.4.1.2. ESBL positive

Preferred regimen: Ertapenem 1 g per day IV OR Imipenem 500 mg IV q6h OR Meropenem 1 g IV q8h OR Doripenem 500 mg IV q8h.
Alternative regimen: Ciprofloxacin IV OR Aztreonam IV.

Pediatric dose:

Meropenem

Neonates

Postnatal age 0–7 days, 20 mg/kg every 12 h.
Postnatal age >7 days and 1200–2000 g, 20 mg/kg every 12 h.
Postnatal age >7 days and >2000 g, 20 mg/kg every 8 h.

Infants ≥3 months of age and children: 20 mg/kg every 8 h.

1.4.2. Enterobacter species and Serratia marcescens

Preferred regimen: Ertapenem 1 g per day IV OR Imipenem 500 mg IV q6h OR Meropenem 1 g IV q8h.
Alternative regimen: Cefepime IV OR Ciprofloxacin IV.
Pediatric dose:

Cefepime

Neonates 14 days of age: 30 mg/kg every 12 h.
Infants >14 days of age and Children 40 kg in weight: 50 mg/kg every 12 h.

1.4.3. Acinetobacter

Preferred regimen: Ampicillin/Sulbactam 3 g IV q6h OR Imipenem 500 mg IV q6h OR Meropenem 1 g IV q8h.

1.4.4. Stenotrophomonas maltophilia

Preferred regimen: Trimethoprim-sulfamethoxazole 3–5 mg/kg IV q8h.
Alternative regimen: Ticarcillin IV AND Clavulanate IV.
Pediatric dose:

Ticarcillin

Neonates

Postnatal age <=7 days and 2000 g, 150 mg/kg/day in divided doses every 12 h.
Postnatal age <=7 days and >2000 g, 225 mg/kg/day in divided doses every 8 h.
Postnatal age >7 days and <1200 g, 150 mg/kg/day in divided doses every 12 h.
Postnatal age >7 days and 1200–2000 g, 225 mg/kg/day in divided doses every 8h.
Postnatal age >7 days and >2000 g, 300 mg/kg/day in divided doses every 6–8 h.

Infants and children: 200–300 mg/kg/day in divided doses every 4–6 2.

1.4.5. Pseudomonas aeruginosa

Preferred regimen: Cefepime, 2 g IV q8h OR Imipenem 500 mg IV q6h OR Meropenem 1 g IV q8h OR Piperacillin IV and Tazobactum 4.5 g IV q6h OR Amikacin 15 mg/kg once a day IV OR Tobramycin 5–7 mg/kg once a day IV.
Pediatric dose:

Amikacin

Neonates

0–4 weeks of age and <1200 g, 7.5 mg/kg every 18–24 h.
Postnatal age <=7 days and 1200–2000 g, 7.5 mg/ kg every 12 h.
Postnatal age <=7 days and >2000 g, 7.5–10 mg/kg every 12 h.
Postnatal age >7 days and 1200–2000 g, 7.5–10 mg/kg every 8–12 h.
Postnatal age >7 days and >2000 g, 10 mg/kg every 8 h.
Infants and children: 15–22.5 mg/kg/day divided every 8 h.

1.4.6. Burkholderia cepacia

Preferred regimen: Trimethoprim-sulfamethoxazole 3–5 mg/kg IV q8h OR Imipenem 500 mg IV q6h OR Meropenem 1g IV q8h.

1.2. Fungi

1.2.1. Candida albicans or other Candida species

Preferred regimen: Caspofungin 70-mg loading dose, then 50 mg per day OR Micafungin, 100 mg per day OR Anidulafungin, 200 mg loading dose followed by 100 mg per day OR fluconazole, 400–600 mg per day.
Alternative regimen: Lipid amphotericin B preparations.

Pediatric dose:

Caspofungin

Intravenous dosing: infants and children aged 3 months–17 years: loading dose of 70 mg/m2/day on day 1 followed by 50 mg/m2/day thereafter.

Micafungin

Children 12 years of age: 1–4 mg/kg/day

Anidulafungin

Children 2– 17 years of agea: 1.5 mg/kg/day

1.3. Uncommon pathogens

1.3.1. Corynebacterium jeikeium (group JK)

Preferred regimen: Vancomycin 15 mg/kg IV q12h.
Alternative regimen: Linezolid IV.

1.3.2. Chryseobacterium (Flavobacterium)

Preferred regimen: Levofloxacin 750 mg IV qd.
Alternative regimen: Trimethoprim-sulfamethoxazole IV OR Imipenem IV OR Meropenem IV.

1.3.3. Ochrobacterium anthropi

Preferred regimen: Trimethoprim-sulfamethoxazole 3–5 mg/kg IV q8h OR ciprofloxacin 400 mg IV q12h.

1.3.4. Malassezia furfur

Preferred regimen: Amphotericin B IV.
Alternative regimen: Voriconazole IV.

Pediatric dose:

Voriconazole

Children 12 years of age: 6 mg/kg every 12 h for 2 doses on day 1 (loading dose) followed by 4 mg/kg every 12 h (note: doses as high as 8 mg/kg every 12 h have been reported.

Note (1): Scheduled replacement of intravascular catheters has been proposed as a method to prevent phlebitis and catheter related infections. No specific recommendation can be made regarding routine replacement of catheters that need to be in place for >7 days
Note (2): Peripheral Venous Catheters: Short peripheral catheter sites commonly are rotated at 72–96-hour intervals. There is no need to replace peripheral catheters more frequently than every 72-96 hours to reduce risk of infection and phlebitis in adults. Replace peripheral catheters in children only when clinically indicated. Replace midline catheters only when there is a specific indication.
Note (3): Midline Catheters: Midline catheters were in place a median of 7 days, but for as long as 49 days.
Note (4): Hemodialysis Catheters: Hemodialysis catheters should be avoided in favor of arteriovenous fistulas and grafts. If temporary access is needed for dialysis, a cuffed catheter is preferable to a noncuffed catheter, even in the ICU setting, if the catheter is expected to stay in place for >3 weeks.
Note (5): Pulmonary Artery Catheters: Pulmonary Artery Catheters typically remain in place an average of 3 days.
Note (6): An umbilical catheter may be replaced if it is malfunctioning, and there is no other indication for catheter removal, and the total duration of catheterization has not exceeded 5 days for an umbilical artery catheter or 14 days for an umbilical vein catheter.

Mediastinitis, acute

Treatment secondary to cardiac infection and surgery^[6]

Preferred regimen: Clindamycin 450 mg IV q6h AND Ceftriaxone 2 g IV q24h, for at least 2 weeks

Prophylaxis

Methicillin susceptible staphylococcus aureus infection

Preferred regimen: Second generation cephalosporin.

Methicillin resistant 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): A deep sternal wound infection should be treated with aggressive surgical debridement in the absence of complicating circumstances.
Note (3): Primary or secondary closure with muscle or omental flap is recommended. Vacuum therapy in conjunction with early and aggressive debridement is an effective adjunctive therapy.
Note (4): Use of a continuous intravenous insulin protocol to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding hypoglycemia is indicated to reduce the risk of deep sternal wound infection.
Note (5): The use of intranasal mupirocin is reasonable in nasal carriers of S. aureus.

Myocarditis, viral

Treatment^[7]

Note (1): Mainstay of therapy for myocarditis is supportive care and standard management of CHF. Ribavarin and interferon alpha improved survival in mice with acute myocarditis.
Note (2): Temporary pacemaker insertion is indicated in patients with symptomatic bradycardia and/or heart block during the acute phase of myocarditis.

Note (3): ICD implantation is not indicated during the acute phase of myocarditis.
Note (4): ICD implantation can be beneﬁcial in patients with life-threatening ventricular arrhythmias who are not in the acute phase of myocarditis, as indicated in the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices.
Note (5): Antiarrhythmic therapy can be useful in patients with symptomatic NSVT or sustained VT during the acute phase of myocarditis.

Pericarditis, fungal

Fungal Pericarditis^[8]

Empiric therapy : Fluconazole, Ketoconazole, Itraconazole, Amphotericin B, Liposomal amphotericin B or Amphotericin B lipid complex is indicated.

Histoplasmosis

Preferred regimen: Nonsteroidal anti-inflammatory drugs given during 2–12 weeks.

Note: Corticosteroids and NSAIDs can support the treatment with antifungal drugs. Pericardiocentesis or surgical treatment is indicated for haemodynamic impairment. Pericardiectomy is indicated in fungal constrictive pericarditis.

Nocardiosis

Preferred regimen: Sulfonamides are the drugs of choice.

Note: Corticosteroids and NSAIDs can support the treatment with antifungal drugs. Pericardiocentesis or surgical treatment is indicated for haemodynamic impairment. Pericardiectomy is indicated in fungal constrictive pericarditis.

Actinomycosis

Preferred regimen: Combination of three antibiotics including Penicillin.

Note: Corticosteroids and NSAIDs can support the treatment with antifungal drugs. Pericardiocentesis or surgical treatment is indicated for haemodynamic impairment. Pericardiectomy is indicated in fungal constrictive pericarditis.

Pericarditis, tuberculous

Preferred regimen: Isoniazid 5 mg/kg (300 mg) OD AND Rifampicin 10 mg/kg (600 mg) OD AND Pyrazanamide 1,500 mg OD AND Ethambutol 1,200 OD for 2 months followed by Rifampicin 10 mg/kg (600 mg) OD AND Pyrazanamide 1,500 mg OD for 4 months. Prednisolone 1–2 mg/kg per day for 5–7 days is also given and is progressively reduced to discontinuation in 6–8 weeks^[9].
Pediatric dose: Isoniazid 10–15 mg/kg (300 mg); Rifampin 10–20 mg/kg (600 mg); Pyrazinamide 15–30 mg/kg (2.0 g); Ethambutol 15–20 mg/kg daily (1.0 g).

Note: Intrapericardial drainage is done if needed. If constriction develops inspite of medical therapy, pericardiectomy is indicated.^[8].

Pericarditis, viral

Viral pericarditis^[8]

CMV pericarditis

Preferred regimen: immunoglobulin 1 time per day 4 ml/kg on day 0, 4, and 8; 2 ml/kg on day 12 and 16.

Note: Symptomatic treatment is given to the patients with viral pericarditis while in large effusions and cardiac tamponade pericardiocentesis is necessary. The use of corticosteroid therapy is contraindicated except in patients with secondary tuberculous pericarditis, as an adjunct to tuberculosis treatment. Drainage, if needed is done.

Coxsackie B pericarditis

Preferred regimen: Interferon alpha or beta 2,5 Mio. IU/m² surface area s.c. 3 times per week

Note: Symptomatic treatment is given to the patients with viral pericarditis while in large effusions and cardiac tamponade pericardiocentesis is necessary. The use of corticosteroid therapy is contraindicated except in patients with secondary tuberculous pericarditis, as an adjunct to tuberculosis treatment. Drainage, if needed is done.

Adenovirus and parvovirus B19 perimyocarditis

Preferred regimen: Immunoglobulin 10 g IV at day 1 and 3 for 6–8 hours

Note: Symptomatic treatment is given to the patients with viral pericarditis while in large effusions and cardiac tamponade pericardiocentesis is necessary. The use of corticosteroid therapy is contraindicated except in patients with secondary tuberculous pericarditis, as an adjunct to tuberculosis treatment. Drainage, if needed is done.

Rheumatic fever, primary prophylaxis

Preferred regimen: Penicillin V (Phenoxymethyl penicillin) 500 mg PO 2 to 3 times daily for 10 days OR Amoxicillin 50 mg/kg PO qd (maximum 1 g) oral for 10 days OR Benzathine penicillin G IM 600 000 U for patients ≤27 kg (60 lb); 1 200 000 U for patients >27 kg (60 lb) once.
Alternative regimen: Narrow-spectrum Cephalosporin†(Cephalexin, Cefadroxil) PO for 10 days OR Clindamycin 20 mg/kg per day divided in 3 doses (maximum 1.8 g/d) PO for 10 days OR Azithromycin 12 mg/kg PO qd (maximum 500 mg) for 5 days OR Clarithromycin 15 mg/kg per day PO bid (maximum 250 mg bid) for 10 days.^[10]

Rheumatic fever, secondary prophylaxis

Preferred regimen (1): Penicillin G benzathine 1.2 million units IM every 4 wk
Preferred regimen (2): Penicillin V potassium 250 mg PO bid
Preferred regimen (3): Sulfadiazine 1 g PO qd
Preferred regimen (4): Macrolide or Azalide antibiotic (for patients allergic to Penicillin and Sulfadiazine) varied dose.
Note: Duration of secondary prophylaxis for rheumatic fever differs for different scenarios. For Rheumatic fever with carditis and residual heart disease (persistent VHD) 10 y or until patient is 40 y of age (whichever is longer). For Rheumatic fever with carditis but no residual heart disease (no valvular disease) 10 y or until patient is 21 y of age (whichever is longer). For Rheumatic fever without carditis 5 y or until patient is 21 y of age (whichever is longer).^[11]

Septic pelvic vein thrombophlebitis

Based on the CT and MRI findings septic pelvic vein thrombophlebitis is classified into following categories for management.^[12].

1. Right ovarian vein thrombosis

Preferred regimen (1): Ertapenem 1 g PO qd for 7 days AND Enoxaparin (1 mg/Kg) initially AND 3–6 months of Warfarin (INR 2.5)
Preferred regimen (2): Gentamicin 4 mg/kg AND Ampicillin 2 g AND Clindamycin 1200 mg for 7 days AND Enoxaparin (1 mg/Kg) initially AND 3–6 months Warfarin (INR 2.5).
Note: Repeat CT scan after 3 months. If negative, stop anticoagulation. If still positive for thrombi, anticoagulate for 3 additional months.

2. Pelvic branch vein thrombosis

Preferred regimen (1): Ertapenem 1 g PO qd for 7 days AND Enoxaparin (1 mg/Kg) PO for 2 weeks
Preferred regimen (2): Gentamicin (4 mg/kg) PO AND Ampicillin 2 g PO AND Clindamycin 1200 mg PO for 7 days AND Enoxaparin (1 mg/Kg) for 2 weeks.

3. Negative for pelvic thrombi

Preferred regimen (1): Ertapenem 1 g PO qd for 7 days AND Enoxaparin (1 mg/Kg) for 1 week
Preferred regimen (2): Gentamicin (4 mg/kg) PO qd AND Ampicillin 2 g PO qd AND Clindamycin 1200 mg PO qd for 7 days AND Enoxaparin (1 mg/Kg) PO qd for 1 weeks

References

↑ Foote EA, Postier RG, Greenfield RA, Bronze MS (2005). "Infectious Aortitis". Curr Treat Options Cardiovasc Med. 7 (2): 89–97. PMID 15935117.
↑ Sandoe JA, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P; et al. (2015). "Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE)". J Antimicrob Chemother. 70 (2): 325–59. doi:10.1093/jac/dku383. PMID 25355810.
↑ Harrison JL, Prendergast BD, Sandoe JA (2015). "Guidelines for the diagnosis, management and prevention of implantable cardiac electronic device infection". Heart. 101 (4): 250–2. doi:10.1136/heartjnl-2014-306873. PMID 25550318.
↑ Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB; et al. (2010). "Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association". Circulation. 121 (3): 458–77. doi:10.1161/CIRCULATIONAHA.109.192665. PMID 20048212.
↑ Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMC 4039170. PMID 19489710.
↑ 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.
↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0443068393.
↑ ^8.0 ^8.1 ^8.2 Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y; et al. (2004). "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". Eur Heart J. 25 (7): 587–610. doi:10.1016/j.ehj.2004.02.002. PMID 15120056.
↑ Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN; et al. (2003). "American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis". Am J Respir Crit Care Med. 167 (4): 603–62. doi:10.1164/rccm.167.4.603. PMID 12588714.
↑ Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST; et al. (2009). "Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics". Circulation. 119 (11): 1541–51. doi:10.1161/CIRCULATIONAHA.109.191959. PMID 19246689.
↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline 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". J Am Coll Cardiol. 63 (22): e57–185. doi:10.1016/j.jacc.2014.02.536. PMID 24603191.
↑ Javier Garcia, Ramzi Aboujaoude, Joseph Apuzzio & Jesus R. Alvarez (2006). "Septic pelvic thrombophlebitis: diagnosis and management". Infectious diseases in obstetrics and gynecology. 2006: 15614. doi:10.1155/IDOG/2006/15614. PMID 17485796.

[pmid15935117-1] Foote EA, Postier RG, Greenfield RA, Bronze MS (2005). "Infectious Aortitis". Curr Treat Options Cardiovasc Med. 7 (2): 89–97. PMID 15935117.

[pmid25355810-2] Sandoe JA, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P; et al. (2015). "Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE)". J Antimicrob Chemother. 70 (2): 325–59. doi:10.1093/jac/dku383. PMID 25355810.

[pmid25550318-3] Harrison JL, Prendergast BD, Sandoe JA (2015). "Guidelines for the diagnosis, management and prevention of implantable cardiac electronic device infection". Heart. 101 (4): 250–2. doi:10.1136/heartjnl-2014-306873. PMID 25550318.

[pmid20048212-4] Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB; et al. (2010). "Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association". Circulation. 121 (3): 458–77. doi:10.1161/CIRCULATIONAHA.109.192665. PMID 20048212.

[pmid19489710-5] Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMC 4039170. PMID 19489710.

[pmid22070836-6] 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.

[7] Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0443068393.

[pmid15120056-8] 8.0 ^8.1 ^8.2 Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y; et al. (2004). "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". Eur Heart J. 25 (7): 587–610. doi:10.1016/j.ehj.2004.02.002. PMID 15120056.

[pmid12588714-9] Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN; et al. (2003). "American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis". Am J Respir Crit Care Med. 167 (4): 603–62. doi:10.1164/rccm.167.4.603. PMID 12588714.

[pmid19246689-10] Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST; et al. (2009). "Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics". Circulation. 119 (11): 1541–51. doi:10.1161/CIRCULATIONAHA.109.191959. PMID 19246689.

[pmid24603191-11] Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline 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". J Am Coll Cardiol. 63 (22): e57–185. doi:10.1016/j.jacc.2014.02.536. PMID 24603191.

[12] Javier Garcia, Ramzi Aboujaoude, Joseph Apuzzio & Jesus R. Alvarez (2006). "Septic pelvic thrombophlebitis: diagnosis and management". Infectious diseases in obstetrics and gynecology. 2006: 15614. doi:10.1155/IDOG/2006/15614. PMID 17485796.

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Sandbox ID Cardiovascular: Difference between revisions

Latest revision as of 20:08, 14 August 2015

Contents

Aortitis, infectious

Cardiovascular implantable electronic device infections

Intravascular catheter-related infections

Mediastinitis, acute

Myocarditis, viral

Treatment^[7]

Pericarditis, fungal

Pericarditis, tuberculous

Pericarditis, viral

Rheumatic fever, primary prophylaxis

Rheumatic fever, secondary prophylaxis

Septic pelvic vein thrombophlebitis

References

Navigation menu

@@ Line 1: / Line 1: @@
-===Endocarditis===
+===Aortitis, infectious===
-{{Details-tx|Endocarditis antimicrobial treatment}}
+:* Preferred regimen<ref name="pmid15935117">{{cite journal| author=Foote EA, Postier RG, Greenfield RA, Bronze MS| title=Infectious Aortitis. | journal=Curr Treat Options Cardiovasc Med | year= 2005 | volume= 7 | issue= 2 | pages= 89-97 | pmid=15935117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15935117  }} </ref>(1): [[Cefotaxime sodium]] 1.0 to 2.0 g IV qd
+:* Preferred regimen (2): [[Ciprofloxacin hydrochloride]] 400 mg IV q12h {{or}} [[Ciprofloxacin hydrochloride]] 500 to 750 mg PO q12h {{or}} [[Levofloxacin]] 250 to 750 mg IV/PO qd
+:* Preferred regimen (3): [[Oxacillin]] 1.0 to 2.0g IV or IM q4h / q6h {{or}} [[Nafcillin]]  1.0 to 2.0 g IV or IM q4h / q6h {{or}} [[Dicloxacillin]]  500 mg to 1.0 g IV or IM q4h /q6h
+:* Preferred regimen (4): [[Vancomycin]] 1.0 g (15 mg/kg, up to 3.0 to 4.0 g/d) IV q12h
+:* Note: Antimicrobial treatments are most effective when bactericidal, broadspectrum [[antibiotics]] are begun after obtaining [[blood cultures]] and prior to [[surgery]]. Dose of [[Cefotaxime sodium]] should be decreased by 50% in those with a [[creatinine]] clearance (CCr) of ≤ 20 mL/min. [[Ciprofloxacin]] should be used cautiously in those with a CCr ≤ 50 mL/min or when given concomitantly with drugs whose metabolism may be altered.
-* Culture-directed antimicrobial therapy<ref>{{Cite journal| doi = 10.1161/CIRCULATIONAHA.105.165564| issn = 1524-4539| volume = 111| issue = 23| pages = –394-434| last1 = Baddour| first1 = Larry M.| last2 = Wilson| first2 = Walter R.| last3 = Bayer| first3 = Arnold S.| last4 = Fowler| first4 = Vance G.| last5 = Bolger| first5 = Ann F.| last6 = Levison| first6 = Matthew E.| last7 = Ferrieri| first7 = Patricia| last8 = Gerber| first8 = Michael A.| last9 = Tani| first9 = Lloyd Y.| last10 = Gewitz| first10 = Michael H.| last11 = Tong| first11 = David C.| last12 = Steckelberg| first12 = James M.| last13 = Baltimore| first13 = Robert S.| last14 = Shulman| first14 = Stanford T.| last15 = Burns| first15 = Jane C.| last16 = Falace| first16 = Donald A.| last17 = Newburger| first17 = Jane W.| last18 = Pallasch| first18 = Thomas J.| last19 = Takahashi| first19 = Masato| last20 = Taubert| first20 = Kathryn A.| last21 = Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease| last22 = Council on Cardiovascular Disease in the Young| last23 = Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia| last24 = American Heart Association| last25 = Infectious Diseases Society of America| title = 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| journal = Circulation| date = 2005-06-14| pmid = 15956145}}</ref>
+===Cardiovascular implantable electronic device infections===
-:* [[Viridans group streptococci]] and [[Streptococcus bovis]]
+:* 1.1. '''Early post-implantation inflammation<ref name="pmid25355810">{{cite journal| author=Sandoe JA, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P et al.| title=Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). | journal=J Antimicrob Chemother | year= 2015 | volume= 70 | issue= 2 | pages= 325-59 | pmid=25355810 | doi=10.1093/jac/dku383 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25355810  }} </ref><ref name="pmid25550318">{{cite journal| author=Harrison JL, Prendergast BD, Sandoe JA| title=Guidelines for the diagnosis, management and prevention of implantable cardiac electronic device infection. | journal=Heart | year= 2015 | volume= 101 | issue= 4 | pages= 250-2 | pmid=25550318 | doi=10.1136/heartjnl-2014-306873 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25550318  }} </ref><ref name="pmid20048212">{{cite journal| author=Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB et al.| title=Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. | journal=Circulation | year= 2010 | volume= 121 | issue= 3 | pages= 458-77 | pmid=20048212 | doi=10.1161/CIRCULATIONAHA.109.192665 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20048212  }} </ref>'''
-::* '''Native valve endocarditis caused by highly penicillin-susceptible viridans group streptococci and Streptococcus bovis (MIC ≤ 0.12 μg/mL)'''
+::* Preferred regimen: [[Flucloxacillin]] 0.5–1 g PO tid
-:::* 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)'''
+:* 1.2. '''Penicillin allergy or MRSA Colonisation'''
-:::* 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: [[Doxycycline]] 100 mg PO bid {{or}} [[Linezolid]] 600 mg PO bid {{or}} [[Clindamycin]] 450 mg po qid
-:::* Preferred regimen (2): [[Vancomycin]] 30 mg/kg/24h IV q12h not to exceed 2 g/24h for 4 weeks.
+::* Note: Benefit of and need for antimicrobial therapy in early post-implantation [[inflammation]] is unclear.
-:::* 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)'''
+:* 1.3. '''Early post-implantation inflammation in penicillin-allergic or MRSA-colonized patient'''
-:::* 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) {{withorwithout}} [[Gentamicin]] 3 mg/kg/24h IV/IM in 1 dose for 2 weeks.
+::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{or}} [[Linezolid]] 600 mg PO bid {{or}} [[Clindamycin]] 450 mg PO qid
-:::* 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)'''
+:* 1.4. '''Uncomplicated generator pocket infection'''
-:::* 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: [[Vancomycin]] 1 g [[IV]] q12h {{or}} [[Daptomycin]] 4 mg/kg [[IV]] qd {{or}} [[Teicoplanin]] 6 mg/kg to a maximum of 1 g IV given at 0, 12 and 24 h and then qd
-:::* 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.
-:* [[Staphylococcus]]
+:* 1.5. '''ICED-LI or ICED-IE or complicated generator pocket infection pending blood cultures, e.g. in severe sepsis'''
-::* '''Native valve endocarditis caused by oxacillin-susceptible staphylococci'''
+::* Preferred regimen: [[Vancomycin]] 1 g IV q12h {{and}} [[Meropenem]] 1 g IV q8h {{or}} [[Daptomycin]] 8–10 mg/kg IV qd {{and}} [[Meropenem]] 1 g [[IV]] q8h
-:::* Preferred regimen (1): [[Nafcillin]] or [[Oxacillin]] 12 g/24h IV q4–6h for 6 weeks {{withorwithout}} [[Gentamicin]] 3 mg/kg/24h IV/IM q8–12h for 3–5 days.
+::* Note: [[Gentamicin]] or other anti-Gram-negative agents may be appropriate depending on local epidemiology.
-:::* Preferred regimen (2): [[Cefazolin]] 6 g/24h IV q8h for 6 weeks {{withorwithout}} [[Gentamicin]] 3 mg/kg/24h IV/IM q8–12h for 3–5 days.
-:::* Pediatric dose: [[Nafcillin]] or [[Oxacillin]] 200 mg/kg/24h IV q4–6h; [[Gentamicin]] 3 mg/kg/24h IV/IM q8h; [[Cefazolin]] 100 mg/kg/24h IV q8h; [[Gentamicin]] 3 mg/kg/24h IV/IM q8h.
-::* '''Native valve endocarditis caused by oxacillin-resistant staphylococci'''
+:* 1.6. '''ICED-LI or ICED-IE or generator pocket infection with negative blood cultures'''
-:::* Preferred regimen: [[Vancomycin]] 30 mg/kg/24h IV q12h for 6 weeks.
+::* Preferred regimen: [[Vancomycin]] 1 g [[IV]] q12h {{and}} [[Gentamicin]] 1 mg/kg IV q12h {{or}} [[Daptomycin]] 8–10 mg/kg [[IV]] qd {{and}} [[Gentamicin]] 1 mg/kg [[IV]] q12h
-:::* Pediatric dose: [[Vancomycin]] 40 mg/kg/24h IV q8–12h.
+::* Note: Duration of antimicrobial therapy should be at least 4 to 6 weeks for complicated [[infection]] (ie, [[endocarditis]], [[septic thrombophlebitis]], or [[osteomyelitis]] or if bloodstream [[infection]] persists despite [[device]] removal and appropriate initial antimicrobial therapy.
+----
-::* '''Prosthetic valve endocarditis caused by oxacillin-susceptible staphylococci'''
-:::* Preferred regimen: [[Nafcillin]] or [[Oxacillin]] 12 g/24h IV q4h 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: [[Nafcillin]] or [[Oxacillin]] 200 mg/kg/24h IV q4–6h; [[Rifampin]] 20 mg/kg/24h IV/PO q8h; [[Gentamicin]] 3 mg/kg/24h IV/IM q8h.
-::* '''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.
-:* [[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'''
-:::* Preferred regimen : [[Ampicillin]] 12 g/24h IV q4h for 4–6 weeks {{or}} [[Penicillin G]] 24 million U/24h IV continuously or q4h for 4–6 weeks {{and}} [[Streptomycin]] 15 mg/kg/24h IV/IM q12h for 4–6 weeks.
-:::* Alternative regimen : [[Vancomycin]] 30 mg/kg/24h IV q12h for 6 weeks {{and}} [[Streptomycin]] 15 mg/kg/24h IV/IM q12h for 6 weeks.
-:::* Pediatric dose: [[Ampicillin]] 300 mg/kg/24h IV q4–6h; [[Penicillin]] 300 000 U/kg/24h IV q4–6h; [[Streptomycin]] 20–30 mg/kg/24h IV/IM q12h; [[Vancomycin]] 40 mg/kg/24h IV q8–12h; [[Streptomycin]] 20–30 mg/kg/24h IV/IM q12h.
-::* '''Endocarditis caused by enterococcal strains resistant to penicillin and susceptible to aminoglycoside and vancomycin'''
-:::* β-Lactamase–producing strain
-::::* Preferred regimen: [[Ampicillin-sulbactam]] 12 g/24h IV q6h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg/24h IV/IM q8h for 6 weeks.
-::::* Alternative regimen : [[Vancomycin]] 30 mg/kg/24h IV q12h for 6 weeks.
-::::* Pediatric dose: [[Ampicillin-sulbactam]] 300 mg/kg/24h IV q6h; [[Gentamicin]] 3 mg/kg/24h IV/IM q8h
-:::* Intrinsic penicillin resistance
-::::* Preferred 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 resistant to penicillin, gentamicin, and vancomycin'''
-:::* Enterococcus faecium
-::::* Preferred regimen : [[Linezolid]] 1200 mg/24h IV/PO q12h for ≥ 8 weeks {{or}} [[Quinupristin-Dalfopristin]] 22.5 mg/kg/24h IV q8h for 8 weeks.
-:::* Enterococcus faecalis
-::::* Preferred regimen : [[Imipenem/cilastatin]] 2 g/24h IV q6h for ≥ 8 weeks {{and}} [[Ampicillin]] 12 g/24h IV q4h for ≥ 8 weeks  {{or}} [[Ceftriaxone sodium]] 4 g/24h IV/IM q12h for ≥ 8 weeks {{and}} [[Ampicillin]] 12 g/24h IV q4h for ≥ 8 weeks.
-::::* Pediatric dose: [[Linezolid]] 30 mg/kg/24h IV/PO q8h; [[Quinupristin-Dalfopristin]] 22.5 mg/kg/24h IV q8h; [[Imipenem/cilastatin]] 60–100 mg/kg/24h IV q6h; [[Ampicillin]] 300 mg/kg/24h IV q4–6h; [[Ceftriaxone]] 100 mg/kg/24h IV/IM q12h.
-:* [[HACEK organisms]]
-::* '''Endocarditis caused by Haemophilus, Aggregatibacter (Actinobacillus), Cardiobacterium, Eikenella corrodens, or Kingella'''
-:::* Preferred regimen : [[Ceftriaxone sodium]] 2 g/24h IV/IM in 1 dose for 4 weeks {{or}} [[Ampicillin]] 12 g/24h IV q6h for 4 weeks {{or}} [[Ciprofloxacin]] 1000 mg/24h PO or 800 mg/24h IV q12h for 4 weeks.
-:::* Pediatric dose: [[Ceftriaxone]] 100 mg/kg/24h IV/IM once daily; [[Ampicillin-sulbactam]] 300 mg/kg/24h IV divided into 4 or 6 equally divided doses; [[Ciprofloxacin]] 20–30 mg/kg/24h IV/PO q12h.
-:* [[Bartonella]]
-::* '''Suspected Bartonella endocarditis'''
-:::* Preferred regimen : [[Ceftriaxone sodium]] 2 g/24h IV/IM in 1 dose for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg/24h IV/IM q8h for 2 weeks {{withorwithout}} [[Doxycycline]] 200 mg/kg/24h IV/PO q12h for 6 weeks.
-:::* Pediatric dose: [[Ceftriaxone]] 100 mg/kg/24h IV/IM once daily; [[Gentamicin]] 3 mg/kg/24h IV/IM q8h; [[Doxycycline]] 2–4 mg/kg/24h IV/PO q12h; [[Rifampin]] 20 mg/kg/24h PO/IV q12h.
-::* '''Documented Bartonella endocarditis'''
-:::* Preferred regimen: [[Doxycycline]] 200 mg/24h IV or PO q12h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg/24h IV/IM q8h for 2 weeks.
-:::* Pediatric dose: [[Ceftriaxone]] 100 mg/kg/24h IV/IM once daily; [[Gentamicin]] 3 mg/kg/24h IV/IM q8h; [[Doxycycline]] 2–4 mg/kg/24h IV/PO q12h; [[Rifampin]] 20 mg/kg/24h PO/IV q12h.
-:* [[Culture-negative endocarditis]]
-::* '''Culture-negative, native valve endocarditis'''
-:::* Preferred regimen: [[Ampicillin-sulbactam]] 12 g/24h IV q6h 4–6 weeks {{and}} [[Gentamicin]] 3 mg/kg/24h IV/IM q8h for 4–6 weeks.
-:::* Alternative regimen: [[Vancomycin]] 30 mg/kg/24h IV q12h for 4–6 weeks {{and}} [[Gentamicin]] 3 mg/kg/24h IV/IM q8h for 4–6 weeks {{and}} [[Ciprofloxacin]] 1000 mg/24h PO or 800 mg/24h IV q12h for 4–6 weeks.
-:::* Pediatric dose: [[Ampicillin-sulbactam]] 300 mg/kg/24h IV q4–6h; [[Gentamicin]] 3 mg/kg/24h IV/IM q8h; [[Vancomycin]] 40 mg/kg/24h q8–12h; [[Ciprofloxacin]] 20–30 mg/kg/24h IV/PO q12h.
-::* '''Culture-negative, prosthetic valve endocarditis (early, ≤ 1 year)'''
-:::* Preferred regimen : [[Vancomycin]] 30 mg/kg/24h IV q12h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg/24h IV/IM q8h for 2 weeks {{and}} [[Cefepime]] 6 g/24h IV q8h for 6 weeks {{and}} [[Rifampin]] 900 mg/24h PO/IV q8h for 6 weeks.
-:::* Pediatric dose: [[Vancomycin]] 40 mg/kg/24h IV q8–12h; [[Gentamicin]] 3 mg/kg/24h IV/IM q8h; [[Cefepime]] 150 mg/kg/24h IV q8h; [[Rifampin]] 20 mg/kg/24h PO/IV q8h.
-::* '''Culture-negative, prosthetic valve endocarditis (late, > 1 year)'''
-:::* Preferred regimen: [[Ampicillin-sulbactam]] 12 g/24h IV q6h 6 weeks {{and}} [[Gentamicin]] 3 mg/kg/24h IV/IM q8h for 6 weeks.
-:::* Alternative regimen: [[Vancomycin]] 30 mg/kg/24h IV q12h for 4–6 weeks {{and}} [[Gentamicin]] 3 mg/kg/24h IV/IM q8h for 6 weeks {{and}} [[Ciprofloxacin]] 1000 mg/24h PO or 800 mg/24h IV q12h for 6 weeks.
-:::* Pediatric dose: [[Ampicillin-sulbactam]] 300 mg/kg/24h IV q4h; [[Gentamicin]] 3 mg/kg/24h IV/IM q8h; [[Vancomycin]] 40 mg/kg/24h q8–12h; [[Ciprofloxacin]] 20–30 mg/kg/24h IV/PO q12h.
-::* '''Culture-negative, prosthetic valve endocarditis (early, ≤ 1 year)'''
-:::* Preferred regimen: [[Ampicillin-sulbactam]] 12 g/24h IV q6h 4–6 weeks {{and}} [[Gentamicin]] 3 mg/kg/24h IV/IM q8h for 4–6 weeks {{and}} [[Rifampin]] 900 mg/24h PO/IV q8h for 6 weeks.
-:::* Alternative regimen: [[Vancomycin]] 30 mg/kg/24h IV q12h for 4–6 weeks {{and}} [[Gentamicin]] 3 mg/kg/24h IV/IM q8h for 4–6 weeks {{and}} [[Ciprofloxacin]] 1000 mg/24h PO or 800 mg/24h IV q12h for 4–6 weeks {{and}} [[Rifampin]] 900 mg/24h PO/IV q8h for 6 weeks.
-:::* Pediatric dose: [[Ampicillin-sulbactam]] 300 mg/kg/24h IV q4–6h; [[Gentamicin]] 3 mg/kg/24h IV/IM q8h; [[Vancomycin]] 40 mg/kg/24h IV q8–12h; [[Cefepime]] 150 mg/kg/24h IV q8h; [[Rifampin]] 20 mg/kg/24h PO/IV q8h.
+===Intravascular catheter-related infections===
+* 1. Pathogen based treatment<ref name="pmid19489710">{{cite journal| author=Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP et al.| title=Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 49 | issue= 1 | pages= 1-45 | pmid=19489710 | doi=10.1086/599376 | pmc=PMC4039170 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19489710  }} </ref>
+:* 1.1. '''Gram positive bacilli'''
+::* 1.1.1 '''Staphylococcus aureus'''
+:::* 1.1.1.1. '''Methicillin susceptible'''
+::::* Preferred regimen: [[Naficillin]]  2 g IV q6h {{or}} [[Oxacillin]] 2 g IV q6h
+::::* Alternative regimen: [[Cefazolin]], 2 g IV q8h {{or}} [[Vancomycin]] 15 mg/kg IV q12h
+::::* Pediatric doses:
+:::::* [[Nafcillin]]
+::::::* Neonates
+:::::::* 0–4 weeks of age and 1200 g- 50 mg/kg/day in divided doses every 12 h
+:::::::* <=7 days and 1200–2000 g- 50 mg/kg/day in divided doses every 12 h
+:::::::* >7 days of age and <2000g- 75 mg/kg/day in divided doses every 8 h
+:::::::* >7 days of age and >1200 g - 100 mg/kg/day in divided doses every 6 h
+:::::* [[Oxacillin]]
+::::::* Neonates
+:::::::* 0–4 weeks of age and 1200 g- 50 mg/kg/day in divided doses every 12 h
+:::::::* Postnatal age < 7 days and 1200–2000 g- 50–100 mg/kg/day in divided doses every 12 h
+:::::::* Postnatal age < 7 days and >2000 g, 75–150 mg/kg/day in divided doses every 8 h
+:::::::* Postnatal age >=7 days and 1200–2000 g- 75–150 mg/kg/day in divided doses every 8 h
+:::::::* Postnatal age >=7 days and >2000 g, 100–200 mg/kg/day in divided doses every 6 h
+::::::* Infants and children [[Nafcillin]] 100–200 mg/kg/day in divided doses every 4–6 h
+:::::* [[Cefazolin]]
+::::::* Neonates
+:::::::* Postnatal age <=7 days: 40 mg/kg/day divided every 12 h
+:::::::* Postnatal age >7 days and 2000 g: 40 mg/kg/day divided every 12 h
+:::::::* Postnatal age >7 days and 12000 g: 60 mg/kg/day divided every 8 h
+::::::* Infants and children: 50 mg/kg/day divided every 8 h
+:::::* [[Vancomycin]]
+::::::* Neonates
+:::::::* Postnatal age <=7 days and <1200 g, 15 mg/kg/day given every 24 h
+:::::::* Postnatal age <=7 days and 1200–2000 g, 10–15 mg/kg given every 12–18 h
+:::::::* Postnatal age <=7 days and >2000 g, 10–15 mg/kg given every 8–12 h
+:::::::* Postnatal age >7 days and <1200 g, 15 mg/kg/day given every 24 h
+:::::::* Postnatal age >7 days and 1200–2000 g, 10–15 mg/kg given every 8–12 h
+:::::::* Postnatal age >7 days and >2000 g, 15–20 mg/kg given every 8 h
+::::::* Infants and children: 40 mg/kg/day in divided doses every 6–8 h
+:::* 1.1.1.2. '''Methicillin resistant Staphylococcus aureus'''
+::::* Preferred regimen: ([[Vancomycin]] 15 mg/kg IV q12h {{or}} [[Daptomycin]] 6–8 mg/kg per day IV, or [[Linezolid]] IV; {{or}} [[Vancomycin]] IV) {{and}} ([[Rifampicin]] IV {{or}} [[Gentamycin]] IV {{or}} [[TMP-SMZ]] IV alone) (if susceptible).
+::::* Pediatric dose
+:::::* [[Linezolid]]
+::::::* Neonates
+:::::::* 0–4 weeks of age and birthweight <1200 g: 10 mg/kg every 8–12 h (note: use every 12 h in patients <34 weeks gestation and <1 week of age)
+:::::::* <7 days of age and birthweight >1200 g, 10 mg/kg every 8–12 h (note: use every 12 h in patients <34 weeks gestation and <1 week of age)
+:::::::* 7 days and birthweight >1200 g, 10 mg/kg every 8 h
+::::::* Infants and children <12 years of age: 10 mg/kg every 8 h Children 12 years of age and adolescents: 10 mg/kg every 12 h
+:::::* [[Gentamycin]]
+::::::* Neonates
+:::::::* Premature neonates and <1000 g, 3.5 mg/kg every 24 h; 0–4 weeks and <1200 g, 2.5 mg/kg every 18–24 h
+:::::::* Postnatal age 7 days: 2.5 mg/kg every 12 h
+:::::::* Postnatal age 17 days and 1200–2000 g, 2.5 mg/kg every 8–12 h
+:::::::* Postnatal age 17 days and 12000 g, 2.5 mg/kg every 8 h
+:::::::* Once daily dosing for premature neonates with normal renal function, 3.5–4 mg/kg every 24 h
+:::::::* Once daily dosing for term neonates with normal renal function, 3.5–5 mg/kg every 24 h
+::::::* Infants and children <5 years of age: 2.5 mg/kg every 8 h; once daily dosing in patients with normal renal function, 5–7.5 mg/kg every 24 h
+::::::* Children >5 years of age: 2–2.5 mg/kg every 8 h; once daily dosing in patients with normal renal function, 5–7.5 mg/kg every 24 h
+:::::* [[TMP-SMZ]]
+::::::*  Infants 12 months of age and children: mild-to-moderate infections, 6–12 mg TMP/kg/day in divided doses every 12 h; serious infection, 15–20 mg TMP/kg/day in divided doses every 6–8 h
+::* 1.2. '''Coagulase-negative staphylococci'''
+:::* [[Methicillin]] susceptible
+::::* Preferred regimen: [[Naficillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h
+::::* Alternative regimen: First-generation [[Cephalosporin]] {{or}} [[Vancomycin]] {{or}} [[TMP-SMZ]]
+:::* Methicillin resistant
+::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h
+::::* Alternative regimen:  [[Daptomycin]] 6 mg/kg per day IV {{or}} [[linezolid]] IV
+::* 1.3. '''Enterococcus faecalis/Enterococcus faecium'''
+:::* [[Ampicillin]] susceptible
+::::* Preferred regimen: [[Ampicillin]], 2 g IV q4h/ q6h;{{or}} [[Ampicillin]] 1 mg/kg IV q8h {{or}} [[Gentamycin]] 1 mg/kg IV q8h.
+::::* Alternative regimen: [[Vancomycin]]
+::::* Pediatric dose:
+:::::* [[Ampicillin]]
+::::::* Neonates
+:::::::* Postnatal age <=7 days and <=2000 g: 50 mg/kg/day divided every 12 h.
+:::::::* Postnatal age <=7 days and >2000 g, 75 mg/kg/day divided every 8 h.
+:::::::* Postnatal age >7 days and <1200 g, 50 mg/kg/day divided every 12 h.
+:::::::* Postnatal age >7 days and 1200–2000 g, 75 mg/kg/day divided every 8 h.
+:::::::* Postnatal age >7 days and >2000 g, 100 mg/kg/day divided every 6 h.
+::::::* Infants and children: 100–200 mg/kg/day divided every 6 h 1
+:::* [[Ampicillin]] resistant, [[Vancomycin]] susceptible
+::::* Preferred regimen: [[Vancomycin]], 15 mg/kg IV q12h '''±''' [[Gentamycin]], 1 mg/kg IV q8h.
+::::* Alternative regimen: [[Linezolid]] 6 mg/kg per day IV  or [[Daptomycin]] 6 mg/kg per day IV.
+:::* [[Ampicillin]] resistant, [[Vancomycin]] resistant
+::::* Preferred regimen: [[Linezolid]] IV 600 mg q12h {{or}} [[Daptomycin]] 6 mg/kg per day IV.
+::::* Alternative regimen: [[Quinupristin]]/[[Dalfopristin]] 7.5 mg/kg IV q8h.
+::* 1.4. '''Gram-negative bacilli'''
+:::* 1.4.1. '''Escherichia coli and Klebsiella species'''
+::::* 1.4.1.1. '''ESBL negative'''
+:::::* Preferred regimen: [[Ceftriaxone]]  1–2 g per day IV.
+:::::* Alternative regimen:  [[Ciprofloxacin]] IV {{or}} [[Aztreonam]] IV.
+:::::* Pediatric dose:
+:::::* [[Ceftriaxone]]
+::::::* Neonates
+:::::::* Postnatal age <=7 days, 50 mg/kg/day given every 24 h.
+:::::::* Postnatal age >7 days and <=2000 g, 50 mg/kg/day given every 24 h.
+:::::::* Postnatal age >7 days and >2000 g, 50–75 mg/kg/day given every 24 h.
+::::::* Infants and children: 50–75 mg/kg/day divided every 12–24 h.
+:::::* [[Ciprofloxacin]]
+::::::* Neonates: 7–40 mg/kg/day divided every 12 h.
+::::::* Infants and children: 20–30 mg/kg/day divided every 12 h.
+::::* 1.4.1.2. '''ESBL positive'''
+:::::* Preferred regimen: [[Ertapenem]] 1 g per day IV {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Doripenem]] 500 mg IV q8h.
+:::::* Alternative regimen:  [[Ciprofloxacin]] IV {{or}} [[Aztreonam]] IV.
+::::* Pediatric dose:
+:::::* [[Meropenem]]
+::::::* Neonates
+:::::::* Postnatal age 0–7 days, 20 mg/kg every 12 h.
+:::::::* Postnatal age >7 days and 1200–2000 g, 20 mg/kg every 12 h.
+:::::::* Postnatal age >7 days and >2000 g, 20 mg/kg every 8 h.
+::::::* Infants ≥3 months of age and children: 20 mg/kg every 8 h.
+:::* 1.4.2. '''Enterobacter species and Serratia marcescens'''
+::::* Preferred regimen: [[Ertapenem]] 1 g per day IV {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h.
+::::* Alternative regimen:  [[Cefepime]] IV {{or}} [[Ciprofloxacin]] IV.
+::::* Pediatric dose:
+:::::* [[Cefepime]]
+::::::* Neonates 14 days of age: 30 mg/kg every 12 h.
+::::::* Infants >14 days of age and Children 40 kg in weight: 50 mg/kg every 12 h.
+:::* 1.4.3. '''Acinetobacter'''
+::::* Preferred regimen: [[Ampicillin]]/[[Sulbactam]] 3 g IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h.
+:::* 1.4.4. '''Stenotrophomonas maltophilia'''
+::::* Preferred regimen: [[Trimethoprim]]-[[sulfamethoxazole]] 3–5 mg/kg IV q8h.
+::::* Alternative regimen: [[Ticarcillin]] IV {{and}} [[Clavulanate]] IV.
+::::* Pediatric dose:
+:::::* [[Ticarcillin]]
+::::::* Neonates
+:::::::* Postnatal age <=7 days and 2000 g, 150 mg/kg/day in divided doses every 12 h.
+:::::::* Postnatal age <=7 days and >2000 g, 225 mg/kg/day in divided doses every 8 h.
+:::::::* Postnatal age >7 days and <1200 g, 150 mg/kg/day in divided doses every 12 h.
+:::::::* Postnatal age >7 days and 1200–2000 g, 225 mg/kg/day in divided doses every 8h.
+:::::::* Postnatal age >7 days and >2000 g, 300 mg/kg/day in divided doses every 6–8 h.
+::::::* Infants and children: 200–300 mg/kg/day in divided doses every 4–6 2.
+:::* 1.4.5. '''Pseudomonas aeruginosa'''
+::::* Preferred regimen: [[Cefepime]], 2 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Piperacillin]] IV  and [[Tazobactum]] 4.5 g IV q6h {{or}} [[Amikacin]] 15 mg/kg once a day IV {{or}} [[Tobramycin]] 5–7 mg/kg once a day IV.
+::::* Pediatric dose:
+:::::* [[Amikacin]]
+::::::* Neonates
+:::::::* 0–4 weeks of age and <1200 g, 7.5 mg/kg every 18–24 h.
+:::::::* Postnatal age <=7 days and 1200–2000 g, 7.5 mg/ kg every 12 h.
+:::::::* Postnatal age <=7 days and >2000 g, 7.5–10 mg/kg every 12 h.
+:::::::* Postnatal age >7 days and 1200–2000 g, 7.5–10 mg/kg every 8–12 h.
+:::::::* Postnatal age >7 days and >2000 g, 10 mg/kg every 8 h.
+:::::::* Infants and children: 15–22.5 mg/kg/day divided every 8 h.
+:::* 1.4.6. '''Burkholderia cepacia'''
+::::* Preferred regimen: [[Trimethoprim]]-[[sulfamethoxazole]] 3–5 mg/kg IV q8h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1g IV q8h.
+:* 1.2. '''Fungi'''
+::* 1.2.1. '''Candida albicans or other Candida species'''
+:::* Preferred regimen: [[Caspofungin]] 70-mg loading dose, then 50 mg per day {{or}} [[Micafungin]], 100 mg per day {{or}}  [[Anidulafungin]], 200 mg loading dose followed by 100 mg per day {{or}} [[fluconazole]], 400–600 mg per day.
+:::* Alternative regimen: [[Lipid]]  [[amphotericin B]] preparations.
+::::* Pediatric dose:
+:::::* [[Caspofungin]]
+::::::* Intravenous dosing: infants and children aged 3 months–17 years: loading dose of 70 mg/m2/day on day 1 followed by 50 mg/m2/day thereafter.
+:::::* [[Micafungin]]
+::::::* Children 12 years of age: 1–4 mg/kg/day
+:::::* [[Anidulafungin]]
+::::::* Children 2– 17 years of agea: 1.5 mg/kg/day
+:* 1.3. '''Uncommon pathogens'''
+::* 1.3.1. '''Corynebacterium jeikeium''' (group JK)
+:::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
+:::* Alternative regimen: [[Linezolid]] IV.
+::* 1.3.2. '''Chryseobacterium (Flavobacterium)'''
+:::* Preferred regimen: [[Levofloxacin]] 750 mg IV qd.
+:::* Alternative regimen: [[Trimethoprim]]-[[sulfamethoxazole]] IV {{or}} [[Imipenem]] IV {{or}} [[Meropenem]] IV.
+::* 1.3.3. '''Ochrobacterium anthropi'''
+:::* Preferred regimen: [[Trimethoprim]]-[[sulfamethoxazole]] 3–5 mg/kg IV q8h {{or}} [[ciprofloxacin]] 400 mg IV q12h.
+::* 1.3.4. '''Malassezia furfur'''
+:::* Preferred regimen: [[Amphotericin B]] IV.
+:::* Alternative regimen:  [[Voriconazole]] IV.
+::::* Pediatric dose:
+:::::* [[Voriconazole]]
+::::::* Children 12 years of age: 6 mg/kg every 12 h for 2 doses on day 1 (loading dose) followed by 4 mg/kg every 12 h (note: doses as high as 8 mg/kg every 12 h have been reported.
+:* Note (1)<ref name=CDC- The Center of disease control and prevention>{{cite web | title = CDC Guidelines for prevention of catheter related infections| url =http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf }}</ref>:  Scheduled replacement of [[intravascular catheters]] has been proposed as a method to prevent [[phlebitis]] and catheter related [[infections]]. No specific recommendation can be made regarding routine replacement of catheters that need to be in place for >7 days
+:* Note (2): [[Peripheral Venous Catheters]]: Short peripheral [[catheter]] sites commonly are rotated at 72–96-hour intervals. There is no need to replace peripheral catheters more frequently than every 72-96 hours to reduce risk of [[infection]] and [[phlebitis]] in adults. Replace peripheral catheters in children only when clinically indicated. Replace midline catheters only when there is a specific indication.
+:* Note (3): Midline Catheters: Midline [[catheters]] were in place a median of 7 days, but for as long as 49 days.
+:* Note (4): Hemodialysis Catheters: [[Hemodialysis]] catheters should be avoided in favor of [[arteriovenous fistulas]] and [[grafts]]. If temporary access is needed for [[dialysis]], a cuffed [[catheter]] is preferable to a noncuffed [[catheter]], even in the [[ICU]] setting, if the [[catheter]] is expected to stay in place for >3 weeks.
+:* Note (5): [[Pulmonary Artery Catheters]]: [[Pulmonary Artery Catheters]] typically remain in place an average of 3 days.
+:* Note (6): An umbilical catheter may be replaced if it is malfunctioning, and there is no other indication for catheter removal, and the total duration of catheterization has not exceeded 5 days for an [[umbilical artery]] catheter or 14 days for an [[umbilical vein]] catheter.
 ----
-===Lyme carditis===
+===Mediastinitis, acute===
-{{Details-tx|Lyme disease medical therapy}}
+* '''Treatment secondary to cardiac infection and surgery<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>'''
+:* Preferred regimen: [[Clindamycin]] 450 mg IV q6h {{and}} [[Ceftriaxone]] 2 g IV q24h, for at least 2 weeks
-* '''Lyme carditis, adult'''<ref>{{Cite journal| doi = 10.1086/508667| issn = 1537-6591| volume = 43| issue = 9| pages = 1089–1134| last1 = Wormser| first1 = Gary P.| last2 = Dattwyler| first2 = Raymond J.| last3 = Shapiro| first3 = Eugene D.| last4 = Halperin| first4 = John J.| last5 = Steere| first5 = Allen C.| last6 = Klempner| first6 = Mark S.| last7 = Krause| first7 = Peter J.| last8 = Bakken| first8 = Johan S.| last9 = Strle| first9 = Franc| last10 = Stanek| first10 = Gerold| last11 = Bockenstedt| first11 = Linda| last12 = Fish| first12 = Durland| last13 = Dumler| first13 = J. Stephen| last14 = Nadelman| first14 = Robert B.| title = The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2006-11-01| pmid = 17029130}}</ref>
+* '''Prophylaxis'''
-:* Parenteral regimen
+:* '''Methicillin susceptible staphylococcus aureus infection'''
-::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 (14–21) days
+::* Preferred regimen: Second generation [[cephalosporin]].
-::* Alternative regimen: [[Cefotaxime]] 2 g IV q8h for 14 (14–21) days {{or}} [[Penicillin G]] 18–24 million U/24h IV q4h for 14 (14–21) days
+:* '''Methicillin resistant staphylococcus aureus infection'''
-:* Oral regimen
+::* Preferred regimen: [[Vancomycin]]
-::* 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
+::* Note (1): Preoperative [[antibiotics]] should be administered to all patients to reduce the risk of [[mediastinitis]] in cardiac surgery.
-::* 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 (2): A deep sternal wound [[infection]] should be treated with aggressive surgical [[debridement]] in the absence of complicating circumstances.
-::: Note: A parenteral antibiotic regimen is recommended at the start of therapy for patients who have been hospitalized for cardiac monitoring; an oral regimen may be substituted to complete a course of therapy or to treat ambulatory patients.  A temporary pacemaker may be required for patients with advanced heart block.  Patients treated with macrolides should be closely observed to ensure resolution of the clinical manifestations.
+::* Note (3): Primary or secondary closure with [[muscle]] or omental flap is recommended. Vacuum therapy in conjunction with early and aggressive [[debridement]] is an effective adjunctive therapy.
+::* Note (4): Use of a continuous intravenous [[insulin]] protocol to achieve and maintain an early postoperative blood [[glucose]] concentration less than or equal to 180 mg/dL while avoiding [[hypoglycemia]] is indicated to reduce the risk of deep sternal wound [[infection]].
-* '''Lyme carditis, pediatric'''<ref>{{Cite journal| doi = 10.1086/508667| issn = 1537-6591| volume = 43| issue = 9| pages = 1089–1134| last1 = Wormser| first1 = Gary P.| last2 = Dattwyler| first2 = Raymond J.| last3 = Shapiro| first3 = Eugene D.| last4 = Halperin| first4 = John J.| last5 = Steere| first5 = Allen C.| last6 = Klempner| first6 = Mark S.| last7 = Krause| first7 = Peter J.| last8 = Bakken| first8 = Johan S.| last9 = Strle| first9 = Franc| last10 = Stanek| first10 = Gerold| last11 = Bockenstedt| first11 = Linda| last12 = Fish| first12 = Durland| last13 = Dumler| first13 = J. Stephen| last14 = Nadelman| first14 = Robert B.| title = The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2006-11-01| pmid = 17029130}}</ref>
+::* Note (5): The use of intranasal [[mupirocin]] is reasonable in nasal carriers of [[S. aureus]].
-:* 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/24h IV q6–8h (maximum, 6 g per day) for 14 (14–21) days {{or}} [[Penicillin G]] 200,000–400,000 U/kg/24h IV q4h (not to exceed 18–24 million U per day) for 14 (14–21) days
-:* Oral regimen
-::* Preferred regimen: [[Amoxicillin]] 50 mg/kg/24h PO tid (maximum, 500 mg per dose) for 14 (14–21) days {{or}} [[Doxycycline]] (for children aged ≥ 􏱢8 years) 4 mg/kg/24h PO bid (maximum, 100 mg per dose) for 14 (14–21) days {{or}} [[Cefuroxime]] 30 mg/kg/24h PO bid (maximum, 500 mg per dose) for 14 (14–21) days
-::* Alternative regimen: [[Azithromycin]] 10 mg/kg/24h (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: A parenteral antibiotic regimen is recommended at the start of therapy for patients who have been hospitalized for cardiac monitoring; an oral regimen may be substituted to complete a course of therapy or to treat ambulatory patients.  A temporary pacemaker may be required for patients with advanced heart block.  Patients treated with macrolides should be closely observed to ensure resolution of the clinical manifestations.
 ----
-===Mycotic aneurysm===
+===Myocarditis, viral===
-{{Details-tx|Mycotic aneurysm#Treatment}}
+===Treatment<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 978-0443068393 }}</ref>===
+::* Note (1): Mainstay of therapy for [[myocarditis]] is supportive care and standard management of [[CHF]]. [[Ribavarin]] and [[interferon alpha]] improved survival in mice with acute [[myocarditis]].
-* '''Empiric antimicrobial therapy'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::* Note (2): [[Temporary pacemaker]] insertion is indicated in patients with symptomatic [[bradycardia]] and/or [[heart block]] during the acute phase of [[myocarditis]].
-:* Preferred regimen: [[Vancomycin]] 2 g/day IV divided q6-12h targeting trough concentration of 15-20 μg/mL for 6 weeks (for critically ill patient, start with a loading dose of 25 mg/kg followed by 15 mg/kg q12h) {{and}} ([[Ceftriaxone]] 2 g IV q24h for 6 weeks {{or}} [[Piperacillin-Tazobactam]] 3.375 g IV q6h for 6 weeks {{or}} [[Ciprofloxacin]] 400 mg IV q12h for 6 weeks)
-:* Alternative regimen: Consider substituting [[Daptomycin]] for Vancomycin.  Consider [[Cefepime]], [[Imipenem-Cilastatin]], [[Meropenem]], or [[Ertapenem]] for Gram-negative bacteria.
+::* Note (3): [[ICD]] implantation is not indicated during the acute phase of [[myocarditis]].
+::* Note (4): [[ICD]] implantation can be beneﬁcial in patients with life-threatening ventricular [[arrhythmias]] who are ''not'' in the acute phase of myocarditis, as indicated in the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices.
+::* Note (5): Antiarrhythmic therapy can be useful in patients with symptomatic NSVT or sustained [[VT]] during the acute phase of [[myocarditis]].
 ----
-===Infectious pericarditis===
+===Pericarditis, fungal===
-{{Details-tx|Pericarditis treatment}}
-* Bacterial pericarditis
-:* '''Empiric antimicrobial therapy'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* 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.
-:* '''Specific considerations'''<ref>{{Cite journal| doi = 10.1016/j.ehj.2004.02.002| issn = 0195-668X| volume = 25| issue = 7| pages = 587–610| last1 = Maisch| first1 = Bernhard| last2 = Seferović| first2 = Petar M.| last3 = Ristić| first3 = Arsen D.| last4 = Erbel| first4 = Raimund| last5 = Rienmüller| first5 = Reiner| last6 = Adler| first6 = Yehuda| last7 = Tomkowski| first7 = Witold Z.| last8 = Thiene| first8 = Gaetano| last9 = Yacoub| first9 = Magdi H.| last10 = Task Force on the Diagnosis and Management of Pricardial Diseases of the European Society of Cardiology| title = 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| journal = European Heart Journal| date = 2004-04| pmid = 15120056}}</ref><ref>{{Cite journal| issn = 1175-3277| volume = 5| issue = 2| pages = 103–112| last1 = Pankuweit| first1 = Sabine| last2 = Ristić| first2 = Arsen D.| last3 = Seferović| first3 = Petar M.| last4 = Maisch| first4 = Bernhard| title = Bacterial pericarditis: diagnosis and management| journal = American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions| date = 2005| pmid = 15725041}}</ref><ref>{{Cite journal| issn = 1092-8464| volume = 2| issue = 4| pages = 343–350| last = Goodman| first = null| title = Purulent Pericarditis| journal = Current Treatment Options in Cardiovascular Medicine| date = 2000-08| pmid = 11096539}}</ref><ref>{{cite book | last = Cherry | first = James | title = Feigin and Cherry's textbook of pediatric infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2014 | isbn = 978-1455711772 }}</ref>
-::* '''Purulent pericarditis with contiguous pneumonia'''
-:::* Preferred regimen: [[Vancomycin]] 1 g IV q12h targeting trough levels of 15–20 μg/mL {{and}} ([[Ceftriaxone]] 1–2 g IV q12h {{or}} [[Cefotaxime]] 2 g IV q6–8h) {{and}} ([[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Levofloxacin]] 500–750 mg IV q24h)
-::* '''Purulent pericarditis with contiguous head and neck infection'''
-:::* Preferred regimen: [[Imipenem]] 500 mg IV q6–8h {{or}} [[Ampicillin-Sulbactam]] 3 g IV q6h
-::* '''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
-:* Culture-directed antimicrobial therapy<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* '''Anaerobes'''
-:::* Preferred regimen: [[Clindamycin]] 600–900 mg IV q8h for 14–42 days {{or}} [[Metronidazole]] 7.5 mg/kg IV q6h for 14–42 days {{or}} [[Ampicillin-Sulbactam]] 3 g IV q6h for 14–42 days
-::* '''Legionella pneumophila'''
-:::* Preferred regimen: [[Ciprofloxacin]] 400 mg IV q12h for 14–42 days {{or}} [[Levofloxacin]] 500–750 mg IV q24h for 14–42 days {{or}} [[Azithromycin]] 500 mg IV q24h for 14–42 days
-::* '''Mycoplasma pneumoniae'''
-:::* Preferred regimen: [[Doxycycline]] 100 mg IV q12h for 14–42 days {{or}} [[Azithromycin]] 500 mg IV q24h for 14–42 days
-::* '''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'''
-:::* 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}} [[Ciprofloxacin]] 400 mg IV q12h for 14–42 days {{or}} [[Levofloxacin]] 500–750 mg IV q24h for 14–42 days
-::* '''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
-::* '''Gram-negative bacilli'''
-:::* Preferred regimen: [[Ciprofloxacin]] 400 mg IV q12h for 14–42 days {{or}} [[Levofloxacin]] 500–750 mg IV q24h for 14–42 days {{or}} [[Cefepime]] 2 g IV q12h for 14–42 days
-* Viral pericarditis<ref name="pmid15120056">{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=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. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15120056  }} </ref>
-:* '''CMV pericarditis'''
-::* Preferred regimen: [[immunoglobulin]] 1 time per day 4 ml/kg on day 0, 4, and 8; 2 ml/kg on day 12 and 16.
-::: Note: Symptomatic treatment is given to the patients with viral [[pericarditis]] while in large effusions and [[cardiac tamponade]] [[pericardiocentesis]] is necessary. The use of [[corticosteroid]] therapy is contraindicated except in patients with secondary [[tuberculous pericarditis]], as an adjunct to [[tuberculosis]] treatment. Drainage, if needed is done.
-:* '''Coxsackie B pericarditis'''
-::* Preferred regimen: [[ Interferon]] alpha or beta 2,5 Mio. IU/m2 surface area s.c. 3×per week.
-::: Note: Symptomatic treatment is given to the patients with viral [[pericarditis]] while in large effusions and [[cardiac tamponade]] [[pericardiocentesis]] is necessary. The use of [[corticosteroid]] therapy is contraindicated except in patients with secondary [[tuberculous pericarditis]], as an adjunct to [[tuberculosis]] treatment. Drainage, if needed is done.
-:* '''Adenovirus and parvovirus B19 perimyocarditis'''
-::* Preferred regimen: [[Immunoglobulin]] 10 g intravenously at day 1 and 3 for 6–8 hours
-::: Note: Symptomatic treatment is given to the patients with viral [[pericarditis]] while in large effusions and [[cardiac tamponade]] [[pericardiocentesis]] is necessary. The use of [[corticosteroid]] therapy is contraindicated except in patients with secondary [[tuberculous pericarditis]], as an adjunct to [[tuberculosis]] treatment. Drainage, if needed is done.
 * Fungal Pericarditis<ref name="pmid15120056">{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=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. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15120056  }} </ref>
-:* Empiric therapy : [[Fluconazole]], [[Ketoconazole]], [[Itraconasole]], [[Amphotericin B]], Liposomal [[amphotericin B]] or [[Amphotericin B]] lipid complex is indicated.
+:* Empiric therapy : [[Fluconazole]], [[Ketoconazole]], [[Itraconazole]], [[Amphotericin B]], Liposomal [[amphotericin B]] or [[Amphotericin B]] lipid complex is indicated.
 ::* [[Histoplasmosis]]
 :::* Preferred regimen: [[Nonsteroidal anti-inflammatory drugs]] given during 2–12 weeks.
@@ Line 220: / Line 246: @@
 ----
-===Myocarditis===
+===Pericarditis, tuberculous===
+:* Preferred regimen: [[Isoniazid]] 5 mg/kg (300 mg) OD  {{and}} [[Rifampicin]]  10 mg/kg (600 mg) OD {{and}} [[Pyrazanamide]]  1,500 mg OD {{and}} [[Ethambutol]] 1,200 OD for 2 months followed by [[Rifampicin]] 10 mg/kg (600 mg) OD {{and}} [[Pyrazanamide]] 1,500 mg OD for 4 months. [[Prednisolone]] 1–2 mg/kg per day for 5–7 days is also given and is progressively reduced to discontinuation in 6–8 weeks<ref name="pmid12588714">{{cite journal| author=Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN et al.| title=American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. | journal=Am J Respir Crit Care Med | year= 2003 | volume= 167 | issue= 4 | pages= 603-62 | pmid=12588714 | doi=10.1164/rccm.167.4.603 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12588714  }} </ref>.
+:* Pediatric dose: [[Isoniazid]]  10–15 mg/kg (300 mg); [[Rifampin]] 10–20 mg/kg (600 mg); [[Pyrazinamide]] 15–30 mg/kg (2.0 g); [[Ethambutol]] 15–20 mg/kg daily (1.0 g).
+:: Note: [[Intrapericardial drainage]] is done if needed. If [[constriction]] develops inspite of medical therapy, [[pericardiectomy]] is indicated.<ref name="pmid15120056">{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=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. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15120056  }} </ref>.
 ----
-===Rheumatic fever===
+===Pericarditis, viral===
+* Viral pericarditis<ref name="pmid15120056">{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=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. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15120056  }} </ref>
+:* '''CMV pericarditis'''
+::* Preferred regimen: [[immunoglobulin]] 1 time per day 4 ml/kg on day 0, 4, and 8; 2 ml/kg on day 12 and 16.
+::: Note: Symptomatic treatment is given to the patients with viral [[pericarditis]] while in large effusions and [[cardiac tamponade]] [[pericardiocentesis]] is necessary. The use of [[corticosteroid]] therapy is contraindicated except in patients with secondary [[tuberculous pericarditis]], as an adjunct to [[tuberculosis]] treatment. Drainage, if needed is done.
+:* '''Coxsackie B pericarditis'''
+::* Preferred regimen: [[ Interferon]] alpha or beta 2,5 Mio. IU/m<sup>2</sup> surface area s.c. 3 times per week
+::: Note: Symptomatic treatment is given to the patients with viral [[pericarditis]] while in large effusions and [[cardiac tamponade]] [[pericardiocentesis]] is necessary. The use of [[corticosteroid]] therapy is contraindicated except in patients with secondary [[tuberculous pericarditis]], as an adjunct to [[tuberculosis]] treatment. Drainage, if needed is done.
+:* '''Adenovirus and parvovirus B19 perimyocarditis'''
+::* Preferred regimen: [[Immunoglobulin]] 10 g IV at day 1 and 3 for 6–8 hours
+::: Note: Symptomatic treatment is given to the patients with viral [[pericarditis]] while in large effusions and [[cardiac tamponade]] [[pericardiocentesis]] is necessary. The use of [[corticosteroid]] therapy is contraindicated except in patients with secondary [[tuberculous pericarditis]], as an adjunct to [[tuberculosis]] treatment. Drainage, if needed is done.
 ----
-===Intravascular catheter-related infections===
+===Rheumatic fever, primary  prophylaxis===
+:* Preferred regimen: [[Penicillin V]] ([[Phenoxymethyl penicillin]]) 500 mg PO 2 to 3 times daily for 10 days {{or}} [[Amoxicillin]] 50 mg/kg PO qd (maximum 1 g) oral for 10 days {{or}} [[Benzathine penicillin G]] [[IM]] 600 000 U for patients ≤27 kg (60 lb); 1 200 000 U for patients >27 kg (60 lb) once.
+:* Alternative regimen: Narrow-spectrum [[Cephalosporin]]†([[Cephalexin]], [[Cefadroxil]]) PO for 10 days {{or}} [[Clindamycin]] 20 mg/kg per day divided in 3 doses (maximum 1.8 g/d) PO for 10 days {{or}} [[Azithromycin]] 12 mg/kg PO qd (maximum 500 mg)  for 5 days {{or}} [[Clarithromycin]] 15 mg/kg per day PO bid (maximum 250 mg bid) for 10 days.<ref name="pmid19246689">{{cite journal| author=Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST et al.| title=Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. | journal=Circulation | year= 2009 | volume= 119 | issue= 11 | pages= 1541-51 | pmid=19246689 | doi=10.1161/CIRCULATIONAHA.109.191959 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19246689  }} </ref>
+----
+===Rheumatic fever, secondary  prophylaxis===
+:* Preferred regimen (1): [[Penicillin G benzathine]] 1.2 million units IM every 4 wk
+:* Preferred regimen (2): [[Penicillin V potassium]] 250 mg PO bid
+:* Preferred regimen (3): [[Sulfadiazine]] 1 g PO qd
+:* Preferred regimen (4): [[Macrolide]] or [[Azalide]] antibiotic (for patients allergic to [[Penicillin]] and [[Sulfadiazine]]) varied dose.
+:* Note: Duration of secondary prophylaxis for [[rheumatic fever]] differs for different scenarios. For [[Rheumatic fever]] with [[carditis]] and residual heart disease (persistent [[VHD]]) 10 y or until patient is 40 y of age (whichever is longer). For [[Rheumatic fever]] with [[carditis]] but no residual [[heart]] disease ([[no valvular disease]]) 10 y or until patient is 21 y of age (whichever is longer). For [[Rheumatic fever]] without [[carditis]] 5 y or until patient is 21 y of age (whichever is longer).<ref name="pmid24603191">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline 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. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= e57-185 | pmid=24603191 | doi=10.1016/j.jacc.2014.02.536 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603191  }} </ref>
 ----
 ===Septic pelvic vein thrombophlebitis===
+* Based on the [[CT]] and [[MRI]] findings [[septic pelvic vein thrombophlebitis]] is classified into following categories for management.<ref>{{Cite journal
+| author = [[Javier Garcia]], [[Ramzi Aboujaoude]], [[Joseph Apuzzio]] & [[Jesus R. Alvarez]]
+ | title = Septic pelvic thrombophlebitis: diagnosis and management
+ | journal = [[Infectious diseases in obstetrics and gynecology]]
+ | volume = 2006
+ | pages = 15614
+ | year = 2006
+ | month =
+ | doi = 10.1155/IDOG/2006/15614
+ | pmid = 17485796
+}}</ref>.
+:* 1. '''Right ovarian vein thrombosis'''
+::* Preferred regimen (1): [[Ertapenem]] 1 g PO qd for 7 days {{and}} [[Enoxaparin]] (1 mg/Kg) initially {{and}}  3–6 months of [[Warfarin]] (INR 2.5)
+::* Preferred regimen (2): [[Gentamicin]] 4 mg/kg {{and}} [[Ampicillin]] 2 g  {{and}} [[Clindamycin]] 1200 mg for 7 days {{and}} [[Enoxaparin]] (1 mg/Kg) initially {{and}}  3–6 months [[Warfarin]] (INR 2.5).
+::* Note: Repeat [[CT]] scan after 3 months. If negative, stop [[anticoagulation]]. If still positive for [[thrombi]], [[anticoagulate]] for 3 additional months.
+:* 2. '''Pelvic branch vein thrombosis'''
+::* Preferred regimen (1): [[Ertapenem]]  1 g PO qd for 7 days {{and}} [[Enoxaparin]] (1 mg/Kg) PO for 2 weeks
+::* Preferred regimen (2): [[Gentamicin]] (4 mg/kg) PO {{and}} [[Ampicillin]] 2 g PO {{and}} [[Clindamycin]] 1200 mg PO for 7 days {{and}} [[Enoxaparin]] (1 mg/Kg) for 2 weeks.
+:* 3. '''Negative for pelvic thrombi'''
+::* Preferred regimen (1): [[Ertapenem]] 1 g PO qd for 7 days {{and}} [[Enoxaparin]] (1 mg/Kg) for 1 week
+::* Preferred regimen (2): [[Gentamicin]]  (4 mg/kg) PO qd {{and}} [[Ampicillin]] 2 g PO qd {{and}} [[Clindamycin]] 1200 mg PO qd for 7 days {{and}} [[Enoxaparin]] (1 mg/Kg) PO qd for 1 weeks
 ----
-===Cardiovascular implantable electronic device infections===
 ==References==
 {{reflist|2}}

Sandbox ID Cardiovascular: Difference between revisions

Latest revision as of 20:08, 14 August 2015

Aortitis, infectious

Cardiovascular implantable electronic device infections

Intravascular catheter-related infections

Mediastinitis, acute

Myocarditis, viral

Treatment[7]

Pericarditis, fungal

Pericarditis, tuberculous

Pericarditis, viral

Rheumatic fever, primary prophylaxis

Rheumatic fever, secondary prophylaxis

Septic pelvic vein thrombophlebitis

References

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Treatment^[7]