Sandbox/002: Difference between revisions
Gerald Chi (talk | contribs) |
Gerald Chi (talk | contribs) m (/* Pathogen-Based Therapy Adapted from Circulation 2005;111(23):e394-434.{{Cite journal | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | l...) |
||
Line 56: | Line 56: | ||
<div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | <div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ ''' | ▸ '''PCN Susceptible, Adult''' | ||
</font> | </font> | ||
</div> | </div> | ||
<div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | <div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ ''' | ▸ '''PCN Susceptible, Pediatric''' | ||
</font> | </font> | ||
</div> | </div> | ||
<div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | <div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ ''' | ▸ '''PCN Resistant, Adult''' | ||
</font> | </font> | ||
</div> | </div> | ||
<div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | <div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ ''' | ▸ '''PCN Resistant, Pediatric''' | ||
</font> | </font> | ||
</div> | </div> | ||
Line 82: | Line 82: | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup> | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup> | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 12—18 MU/day IV continuously | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 12—18 MU/day IV continuously or q4—6h x 4 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV/IM q24h x 4 weeks''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 1'''''<sup>‡</sup> | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 1'''''<sup>‡</sup> | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 12—18 MU/day IV continuously | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 12—18 MU/day IV continuously or q4—6h x 2 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV/IM q24h x 2 weeks''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg IV q24h x 2 weeks'''''<sup>¶</sup> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg IV q24h (or 1 mg/kg IV q8h) x 2 weeks'''''<sup>¶</sup> | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 2''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 2''''' | ||
Line 106: | Line 106: | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup> | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup> | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 0.2 MU/kg/day IV q4—6h x 4 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 100 mg/kg IV/IM q24h x 4 weeks''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 0.2 MU/kg/day IV q4—6h x 4 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 100 mg/kg IV/IM q24h x 4 weeks''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 1'''''<sup>‡</sup> | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 1'''''<sup>‡</sup> | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 0.2 MU/kg/day IV q4—6h x 2 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 100 mg/kg IV/IM q24h x 2 weeks''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 0.2 MU/kg/day IV q4—6h x 2 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 100 mg/kg IV/IM q24h x 2 weeks''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | ||
Line 130: | Line 130: | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 24 MU/day IV continuously | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 24 MU/day IV continuously or q4—6h x 4 weeks'''''<sup>†</sup> <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV/IM q24h x 4 weeks'''''<sup>‡</sup> | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg IV q24h ( | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg IV q24h (1 mg/kg IV q8h) x 2 weeks'''''<sup>¶</sup> | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg/day IV q12h x 4 weeks'''''<sup>ǁ</sup> | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>†</sup> Patients with endocarditis caused by Penicillin Resistant (MIC greater than 0.5 μg/ml) strains should be treated with regimen recommended for enterococcal endocarditis. <BR> <sup>‡</sup> Recommended for enterococcal endocarditis. <BR> <sup>¶</sup> Gentamicin dosage should be adjusted to achieve peak serum concentration of 3—4 μg/ml and trough serum concentration of less than 1 μg/ml when 3 divided doses are used; nomogram used for single daily dosing; other potentially nephrotoxic drugs (e.g., nonsteroidal anti-inflammatory drugs) should be used with caution in patients receiving gentamicin therapy. <BR> <sup>ǁ</sup> Recommended only for patients unable to tolerate penicillin or ceftriaxone. Vancomycin doses should not exceed 2 g per 24 h, unless serum concentrations are inappropriately low. Dosage should be adjusted to obtain peak (1 h after infusion completed) serum concentration of 30–45 μg/ml and a trough concentration range of 10–15 μg/ml. Vancomycin should be infused during course of at least 1 h to reduce risk of histamine-release red man syndrome. | | style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>†</sup> Patients with endocarditis caused by Penicillin Resistant (MIC greater than 0.5 μg/ml) strains should be treated with regimen recommended for enterococcal endocarditis. <BR> <sup>‡</sup> Recommended for enterococcal endocarditis. <BR> <sup>¶</sup> Gentamicin dosage should be adjusted to achieve peak serum concentration of 3—4 μg/ml and trough serum concentration of less than 1 μg/ml when 3 divided doses are used; nomogram used for single daily dosing; other potentially nephrotoxic drugs (e.g., nonsteroidal anti-inflammatory drugs) should be used with caution in patients receiving gentamicin therapy. <BR> <sup>ǁ</sup> Recommended only for patients unable to tolerate penicillin or ceftriaxone. Vancomycin doses should not exceed 2 g per 24 h, unless serum concentrations are inappropriately low. Dosage should be adjusted to obtain peak (1 h after infusion completed) serum concentration of 30–45 μg/ml and a trough concentration range of 10–15 μg/ml. Vancomycin should be infused during course of at least 1 h to reduce risk of histamine-release red man syndrome. | ||
Line 150: | Line 150: | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 0.3 MU/kg/day IV q4—6h x 4 weeks'''''<sup>†</sup> <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 100 mg/kg IV/IM q24h x 4 weeks'''''<sup>‡</sup> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 0.3 MU/kg/day IV q4—6h x 4 weeks'''''<sup>†</sup> <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 100 mg/kg IV/IM q24h x 4 weeks'''''<sup>‡</sup> | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | ||
Line 158: | Line 158: | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 40 mg/kg IV q8—12h x 4 weeks'''''<sup>ǁ</sup> | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>†</sup> Patients with endocarditis caused by Penicillin Resistant (MIC greater than 0.5 μg/ml) strains should be treated with regimen recommended for enterococcal endocarditis. <BR> <sup>‡</sup> Recommended for enterococcal endocarditis. <BR> <sup>¶</sup> Gentamicin dosage should be adjusted to achieve peak serum concentration of 3—4 μg/ml and trough serum concentration of less than 1 μg/ml when 3 divided doses are used; nomogram used for single daily dosing; other potentially nephrotoxic drugs (e.g., nonsteroidal anti-inflammatory drugs) should be used with caution in patients receiving gentamicin therapy. <BR> <sup>ǁ</sup> Recommended only for patients unable to tolerate penicillin or ceftriaxone. Vancomycin doses should not exceed 2 g per 24 h, unless serum concentrations are inappropriately low. Dosage should be adjusted to obtain peak (1 h after infusion completed) serum concentration of 30–45 μg/ml and a trough concentration range of 10–15 μg/ml. Vancomycin should be infused during course of at least 1 h to reduce risk of histamine-release red man syndrome. | | style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>†</sup> Patients with endocarditis caused by Penicillin Resistant (MIC greater than 0.5 μg/ml) strains should be treated with regimen recommended for enterococcal endocarditis. <BR> <sup>‡</sup> Recommended for enterococcal endocarditis. <BR> <sup>¶</sup> Gentamicin dosage should be adjusted to achieve peak serum concentration of 3—4 μg/ml and trough serum concentration of less than 1 μg/ml when 3 divided doses are used; nomogram used for single daily dosing; other potentially nephrotoxic drugs (e.g., nonsteroidal anti-inflammatory drugs) should be used with caution in patients receiving gentamicin therapy. <BR> <sup>ǁ</sup> Recommended only for patients unable to tolerate penicillin or ceftriaxone. Vancomycin doses should not exceed 2 g per 24 h, unless serum concentrations are inappropriately low. Dosage should be adjusted to obtain peak (1 h after infusion completed) serum concentration of 30–45 μg/ml and a trough concentration range of 10–15 μg/ml. Vancomycin should be infused during course of at least 1 h to reduce risk of histamine-release red man syndrome. | ||
Line 178: | Line 178: | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 24 MU/day IV continuously or q4—6h x 6 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV/IM q24h x 6 weeks''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | WITH OR WITHOUT | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | WITH OR WITHOUT | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg IV q24h x 2 weeks'''''<sup>¶</sup> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg IV q24h (or 1 mg/kg IV q8h) x 2 weeks'''''<sup>¶</sup> | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | ||
Line 188: | Line 188: | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q12h x 6 weeks'''''<sup>ǁ</sup> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q12h x 6 weeks'''''<sup>ǁ</sup> | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>¶</sup> Gentamicin | | style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>¶</sup> Gentamicin therapy should not be administered to patients with creatinine clearance of <30 mL/min <BR> <sup>ǁ</sup> Recommended only for patients unable to tolerate penicillin or ceftriaxone. Vancomycin doses should not exceed 2 g per 24 h, unless serum concentrations are inappropriately low. Dosage should be adjusted to obtain peak (1 h after infusion completed) serum concentration of 30–45 μg/ml and a trough concentration range of 10–15 μg/ml. Vancomycin should be infused during course of at least 1 h to reduce risk of histamine-release red man syndrome. | ||
|} | |} | ||
|} | |} | ||
Line 198: | Line 198: | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 0. | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 0.3 MU/kg/day IV q4—6h x 6 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 100 mg/kg IV/IM q24h x 6 weeks''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | WITH OR WITHOUT | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | WITH OR WITHOUT | ||
Line 218: | Line 218: | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 24 MU/day IV continuously or q4—6h x 6 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV/IM q24h x 6 weeks''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg IV q24h x 2 weeks'''''<sup>¶</sup> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3 mg/kg IV q24h (or 1 mg/kg IV q8h) x 2 weeks'''''<sup>¶</sup> | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | ||
Line 238: | Line 238: | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium]] 0.2 MU/kg/day IV q4—6h x 6 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 100 mg/kg IV/IM q24h x 6 weeks''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 0.2 MU/kg/day IV q4—6h x 6 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 100 mg/kg IV/IM q24h x 6 weeks''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | ||
Line 251: | Line 251: | ||
|} | |} | ||
|} | |} | ||
|} | |||
====''Streptococcus pneumoniae'', ''Streptococcus pyogenes'', and Groups B, C, and G Streptococci==== | |||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL> | |||
{| | |||
| valign=top | | |||
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #A1BCDD; text-align: center;"> | |||
<font color="#FFF"> | |||
'''''Streptococcus pneumoniae''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table10" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''PCN Susceptible''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''PCN Resistant, Without Meningitis''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''PCN Resistant, With Meningitis''' | |||
</font> | |||
</div> | |||
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #A1BCDD; text-align: center;"> | |||
<font color="#FFF"> | |||
'''''Streptococcus pyogenes''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table13" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''IE Caused by ''S. pyogenes''''' | |||
</font> | |||
</div> | |||
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #A1BCDD; text-align: center;"> | |||
<font color="#FFF"> | |||
'''Group B, C, and G Streptococcus''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table14" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 310px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''IE Caused by Group B/C/G Streptococcus''' | |||
</font> | |||
</div> | |||
| valign=top | | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table10" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 600px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''S. pneumoniae'' Endocarditis, PCN Susceptible (MIC ≤0.1 μg/mL)}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 12—18 MU/day IV continuously or q4—6h x 4 weeks''''' <BR> OR <BR> ▸ '''''[[Cefazolin]] 1—1.5 g IV/IM q6h x 4 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV/IM q24h x 4 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q12h x 4 weeks'''''<sup>ǁ</sup> | |||
|- | |||
| style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>ǁ</sup> Recommended only for patients unable to tolerate beta-lactams. Vancomycin doses should not exceed 2 g per 24 h, unless serum concentrations are inappropriately low. Dosage should be adjusted to obtain peak (1 h after infusion completed) serum concentration of 30–45 μg/ml and a trough concentration range of 10–15 μg/ml. Vancomycin should be infused during course of at least 1 h to reduce risk of histamine-release red man syndrome. | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table11" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 600px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''S. pneumoniae'' Endocarditis, PCN Resistant (MIC >0.1 μg/mL), Without Meningitis}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G sodium|Penicillin G]] 12—18 MU/day IV continuously or q4—6h x 4 weeks''''' <BR> OR <BR> ▸ '''''[[Cefazolin]] 1—1.5 g IV/IM q6h x 4 weeks''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV/IM q24h x 4 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q12h x 4 weeks'''''<sup>ǁ</sup> | |||
|- | |||
| style="padding: 0 5px; font-size: 80%; background: #F5F5F5;" align=left | <sup>ǁ</sup> Recommended only for patients unable to tolerate beta-lactams. Vancomycin doses should not exceed 2 g per 24 h, unless serum concentrations are inappropriately low. Dosage should be adjusted to obtain peak (1 h after infusion completed) serum concentration of 30–45 μg/ml and a trough concentration range of 10–15 μg/ml. Vancomycin should be infused during course of at least 1 h to reduce risk of histamine-release red man syndrome. | |||
|} | |||
|} | |||
|} | |} | ||
Revision as of 22:39, 5 March 2014
Endocarditis Microchapters |
Diagnosis |
---|
Treatment |
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease |
Case Studies |
Sandbox/002 On the Web |
Pathogen-Based Therapy Adapted from Circulation 2005;111(23):e394-434.[1] and Circulation 2008;118(15):e523-661.[2]
Viridans Streptococci or Streptococcus bovis
▸ Click on the following categories to expand treatment regimens.
Native Valve Endocarditis ▸ Highly PCN Susceptible, Adult ▸ Highly PCN Susceptible, Pediatric ▸ Relatively PCN Resistant, Adult ▸ Relatively PCN Resistant, Pediatric ▸ Highly PCN Resistant Prosthetic Valve Endocarditis ▸ PCN Susceptible, Adult ▸ PCN Susceptible, Pediatric ▸ PCN Resistant, Adult ▸ PCN Resistant, Pediatric |
|
Streptococcus pneumoniae, Streptococcus pyogenes, and Groups B, C, and G Streptococci
▸ Click on the following categories to expand treatment regimens.
Streptococcus pneumoniae ▸ PCN Susceptible ▸ PCN Resistant, Without Meningitis ▸ PCN Resistant, With Meningitis Streptococcus pyogenes ▸ IE Caused by S. pyogenes Group B, C, and G Streptococcus ▸ IE Caused by Group B/C/G Streptococcus |
|
References
- ↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (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: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter
|month=
ignored (help) - ↑ 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)