Sandbox ID Cardiovascular
Aortitis, infectious
- Preferred regimen: Cefotaxime sodium 1.0 to 2.0 g administered intravenously every 24 hours. For infectious aortitis, 2.0 g intravenously every 24 hours is recommended OR Ciprofloxacin hydrochloride 400 mg given intravenously every 12 hours or 500 to 750 mg administered by mouth every 12 hours OR Levofloxacin 250 to 750 mg administered either intravenously or by mouth every 24 hours OR Oxacillin 1.0 to 2.0 g administered intravenously or intramuscularly every 4 to 6 hours Nafcillin 1.0 to 2.0 g administered intravenously or intramuscularly every 4 to 6 hours OR Dicloxacillin 500 mg to 1.0 g every 4 to 6 hours OR Vancomycin 1.0 g (15 mg/kg, up to 3.0 to 4.0 g/d) given every 12 hours.[1]
- Note: 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
- Early post-implantation inflammation
- Preferred regimen: Flucloxacillin 0.5–1 g 6th hourly oral
- Note: Benefit of and need for antimicrobial therapy in Early post-implantation inflammation is unclear.
- Early post-implantation inflammation in penicillin-allergic or MRSA-colonized patient
- Preferred regimen: Doxycycline 100 mg BID Oral OR Linezolid 600 mg BID Oral OR Clindamycin 450 mg 6th hourly oral.
- Uncomplicated generator pocket infection
- Preferred regimen: Vancomycin 1 g BID IV OR Daptomycin 4 mg/kg OD IV OR Teicoplanin 6 mg/kg to a maximum of 1 g given at 0, 12 and 24 h and then OD.
- ICED-LI or ICED-IE or complicated generator pocket infection pending blood cultures, e.g. in severe sepsis
- Preferred regimen: Vancomycin 1 g BID IV AND Meropenem 1 g TID IV OR Daptomycin 8–10 mg/kg OD IV AND Meropenem 1 g TID IV.
- ICED-LI or ICED-IE or generator pocket infection with negative blood cultures
- Preferred regimen: Vancomycin 1 g BID IV AND Gentamicin 1 mg/kg BID IV OR Daptomycin 8–10 mg/kg OD IV AND Gentamicin 1 mg/kg BID IV.
Endocarditis, prophylaxis
Mediastinitis, acute
Myocarditis, viral
Pericarditis, fungal
- Fungal Pericarditis[2]
- Empiric therapy : Fluconazole, Ketoconazole, Itraconazole, Amphotericin B, Liposomal amphotericin B or Amphotericin B lipid complex is indicated.
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- 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.
- 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.
- 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: 2 months of 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 followed by 4 months of Rifampicin 10 mg/kg (600 mg) OD AND Pyrazanamide 1,500 mg OD. Prednisolone 1–2 mg/kg per day for 5–7 days is also given and is progressively reduced to discontinuation in 6–8 weeks[3].
- 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[2].
Pericarditis, viral
- Viral pericarditis[2]
- 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.
Rheumatic fever, primary prophylaxis
- Preferred regimen: Penicillin V (Phenoxymethyl penicillin) 500 mg 2 to 3 times daily oral for 10 days OR Amoxicillin 50 mg/kg once daily (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) oral for 10 days OR Clindamycin 20 mg/kg per day divided in 3 doses (maximum 1.8 g/d) oral for 10 days OR Azithromycin 12 mg/kg once daily (maximum 500 mg) oral for 5 days OR Clarithromycin 15 mg/kg per day divided BID (maximum 250 mg BID) oral for 10 days.[4]
Rheumatic fever, secondary prophylaxis
- Preferred regimen: Penicillin G benzathine 1.2 million units IM every 4 wk OR Penicillin V potassium 250 mg orally BID OR Sulfadiazine 1 g orally once daily OR 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).[5]
Septic pelvic vein thrombophlebitis
- Based on the CT and MRI findings septic pelvic vein thrombophlebitis is classified into following categories for management.[6].
- Right ovarian vein thrombosis
- Preferred regimen: Ertapenem 1 g daily for 7 days AND Enoxaparin (1 mg/Kg) initially AND 3–6 months of Warfarin (INR 2.5) OR 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.
- Pelvic branch vein thrombosis
- Preferred regimen: Ertapenem 1 g daily for 7 days AND Enoxaparin (1 mg/Kg) for 2 weeks OR Gentamicin (4 mg/kg) AND Ampicillin 2 g AND Clindamycin 1200 mg for 7 days AND Enoxaparin (1 mg/Kg) for 2 weeks.
- Negative for pelvic thrombi
- Preferred regimen: Ertapenem 1 g daily for 7 days AND Enoxaparin (1 mg/Kg) for 1 weeks OR Gentamicin (4 mg/kg) AND Ampicillin 2 g AND Clindamycin 1200 mg for 7 days AND Enoxaparin (1 mg/Kg) 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.
- ↑ 2.0 2.1 2.2 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.