Sandbox endocarditis: Difference between revisions

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! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Native valve}}''
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! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Native valve pediatric dose}}''
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! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Prosthetic valve (early, ≤ 1y)}}''
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Prosthetic valve (early, ≤ 1y)}}''
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! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Prosthetic valve pediatric dose}}''
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! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Prosthetic valve (late—greater than 1 y)}}''
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! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Suspected Bartonella, culture negative}}''
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! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Documented Bartonella, culture positive}}''
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! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Documented Bartonella, culture positive pediatric dose}}''
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Revision as of 19:51, 14 January 2014

Empirical Antibiotic Therapy

  • Antibiotic therapy for subacute disease, and in those who have received antibiotics recently can be delayed waiting the results of blood cultures, as this delay allows an additional blood cultures without the confounding effect of empiric treatment, which is very important in determining the causing pathogens.[1]
  • On the other hand, the rapid progression of acute cases necessitate the start of empirical treatment antibiotic therapy once the blood cultures have been collected.
  • Empirical therapy is needed for all likely pathogens, certain antibiotic agents, including aminoglycosides, is preferably avoided for its toxic effects.
  • Clinical course of infection beside the epidemiological features should be considered upon selecting empirical treatment regimen.
  • Consultation with an infectious disease specialist for the selection of one of the antibiotic regimens is recommended(See therapy for culture-negative endocarditis). [2]
Native valve
Regimen Dosage and Route Duration(wk)
Ampicillin sulbactam 12 g per 24 h IV in 4 equally divided doses 4–6
Plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 4–6
Or
Vancomycin 30 mg per kg per 24 h IV in 2 equally divided doses 4–6
Plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 4–6
Plus
Ciprofloxacin 1000 mg per 24 h PO or 800 mg per 24 h IV in 2 equally divided doses 4–6
Native valve pediatric dose
Ampicillin sulbactam 300 mg per kg per 24 h IV in 4–6 equally divided doses
Gentamicin 3 mg per kg per 24 h IV/IM in 3 equally divided doses
Vancomycin 40 mg per kg per 24 h in 2 or 3 equally divided doses
Ciprofloxacin 20–30 mg per kg per 24 h IV/PO in 2 equally divided doses
Prosthetic valve (early, ≤ 1y)
Regimen Dosage and Route Duration(wk)
Vancomycin 30 mg per kg per 24 h IV in 2 equally divided doses 6
Plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 2
Plus
Cefepime 6 g per 24 h IV in 3 equally divided doses 6
Plus
Rifampin 900 mg per 24 h PO/IV in 3 equally divided doses 6
Prosthetic valve pediatric dose
Vancomycin 40 mg per kg per 24 h IV in 2 or 3equally divided doses
Gentamicin 3 mg per kg per 24 h IV/IM in 3 equally divided doses
Cefepime 150 mg per kg per 24 h IV in 3 equally divided doses
Rifampin 20 mg per kg per 24 h PO/IV in 3 equally divided doses
Prosthetic valve (late—greater than 1 y)
Regimen Dosage and Route Duration(wk)
Ampicillin sulbactam 12 g per 24 h IV in 4 equally divided doses 4–6
Plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 4–6
Or
Vancomycin 30 mg per kg per 24 h IV in 2 equally divided doses 4–6
Plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 4–6
Plus
Ciprofloxacin 1000 mg per 24 h PO or 800 mg per 24 h IV in 2 equally divided doses 4–6
Suspected Bartonella, culture negative
Regimen Dosage and Route Duration(wk)
Ceftriaxone sodium 2 g per 24 h IV/IM in 1 dose 6
Plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 2
with/without
Doxycycline 200 mg per kg per 24 h IV/PO in 2 equally divided doses 6
Documented Bartonella, culture positive
Regimen Dosage and Route Duration(wk)
Doxycycline 200 mg per 24 h IV or PO in 2 equally divided doses 6
Plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 2
Documented Bartonella, culture positive pediatric dose
Ceftriaxone 100 mg per kg per 24 h IV/IM once daily
Gentamicin 3 mg per kg per 24 h IV/IM in 3 equally divided doses
Doxycycline 2–4 mg per kg per 24 h IV/PO in 2 equally divided doses
Rifampin 20 mg per kg per 24 h PO/IV in 2 equally divided doses


Regimen Dosage and Route Duration(wk)
Native valve
Ampicillin sulbactam 12 g per 24 h IV in 4 equally divided doses 4–6
plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 4–6
or
Vancomycin 30 mg per kg per 24 h IV in 2 equally divided doses 4–6
plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 4–6
plus
Ciprofloxacin 1000 mg per 24 h PO or 800 mg per 24 h IV in 2 equally divided doses 4–6
Pediatric dose:
  • Ampicillin sulbactam 300 mg per kg per 24 h IV in 4–6 equally divided doses
  • Gentamicin 3 mg per kg per 24 h IV/IM in 3 equally divided doses
  • Vancomycin 40 mg per kg per 24 h in 2 or 3 equally divided doses
  • Ciprofloxacin 20–30 mg per kg per 24 h IV/PO in 2 equally divided doses
Prosthetic valve (early, ≤ 1y)
Vancomycin 30 mg per kg per 24 h IV in 2 equally divided doses 6
plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 2
plus
Cefepime 6 g per 24 h IV in 3 equally divided doses 6
plus
Rifampin 900 mg per 24 h PO/IV in 3 equally divided doses 6
Pediatric dose:
  • Vancomycin 40 mg per kg per 24 h IV in 2 or 3equally divided doses
  • Gentamicin 3 mg per kg per 24 h IV/IM in 3 equally divided doses
  • Cefepime 150 mg per kg per 24 h IV in 3 equally divided doses
  • Rifampin 20 mg per kg per 24 h PO/IV in 3 equally divided doses
Prosthetic valve (late—greater than 1 y) Same regimens as listed above for native valve endocarditis
Suspected Bartonella, culture negative
Ceftriaxone sodium 2 g per 24 h IV/IM in 1 dose 6
plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 2
with/without
Doxycycline 200 mg per kg per 24 h IV/PO in 2 equally divided doses 6
Documented Bartonella, culture positive
Doxycycline 200 mg per 24 h IV or PO in 2 equally divided doses 6
plus
Gentamicin sulfate 3 mg per kg per 24 h IV/IM in 3 equally divided doses 2
Pediatric dose:
  • Ceftriaxone 100 mg per kg per 24 h IV/IM once daily
  • Gentamicin 3 mg per kg per 24 h IV/IM in 3 equally divided doses
  • Doxycycline 2–4 mg per kg per 24 h IV/PO in 2 equally divided doses
  • Rifampin 20 mg per kg per 24 h PO/IV in 2 equally divided doses

Treatment Based Upon Infectious Agent[3]

Penicillin-Susceptible Strep Viridans and Other Nonenterococcal Streptococci

Penicillin G

  • If Minimum inhibitory concentration [MIC] <0.2 µg/ml.
  • Dose: 12–18 million units I.V. daily in divided doses q. 4 hour for 4 weeks.

Penicillin G + Gentamicin

  • Dose: Penicillin G, 12–18 million units I.V. daily in divided doses q. 4 hour for 4 weeks plus gentamicin, 3 mg/kg I.M. or I.V. daily in divided doses q. 8 hour for 2 weeks (peak serum concentration should be ~ 3 µg/ml and trough concentrations < 1 µg/ml).

Ceftriaxone

  • Dose: 2 g I.V. daily as a single dose for 2 weeks.




References

  1. Braunwald, Eugene; Bonow, Robert O. (2012). Braunwald's heart disease : a textbook of cardiovascular medicin. Philadelphia: Saunders. ISBN 978-1-4377-2708-1.
  2. Bonow, RO.; Carabello, BA.; Chatterjee, K.; de Leon, AC.; Faxon, DP.; Freed, MD.; Gaasch, WH.; Lytle, BW.; Nishimura, RA. (2008). "2008 focused update incorporated into the ACC/AHA 2006 guidelines 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 (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (13): e1–142. doi:10.1016/j.jacc.2008.05.007. PMID 18848134. Unknown parameter |month= ignored (help)
  3. Baddour Larry M., Wilson Walter R., Bayer Arnold S., Fowler Vance G. Jr, Bolger Ann F., Levison Matthew E., Ferrieri Patricia, Gerber Michael A., Tani Lloyd Y., Gewitz Michael H., Tong David C., Steckelberg James M., Baltimore Robert S., Shulman Stanford T., Burns Jane C., Falace Donald A., Newburger Jane W., Pallasch Thomas J., Takahashi Masato, Taubert Kathryn A. (2005). "Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association-Executive Summary: Endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): 3167–84. PMID 15956145.