Sandbox ID Cardiovascular

• Endocarditis

• Viridans group streptococci and Streptococcus bovis

• Native valve endocarditis caused by highly penicillin-susceptible viridans group streptococci and Streptococcus bovis (MIC ≤ 0.12 μg/mL)

• Preferred regimen: Penicillin G 12–18 million U/24 h IV either continuously or in 4 or 6 equally divided doses 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/24 h IV either continuously or in 6 equally divided doses for 2 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 2 weeks) AND Gentamicin 3 mg/kg per 24h IV/IM in 1 dose for 2 weeks.
• Alternative regimen (2): Vancomycin 30 mg/kg per 24 h IV in 2 equally divided doses not to exceed 2 g/24 h for 4 weeks.
• Pediatric dose: Penicillin G 200,000 U/kg per 24 h IV in 4–6 equally divided doses; Ceftriaxone 100 mg/kg per 24 h IV/IM in 1 dose; Gentamicin 3 mg/kg per 24 h IV/IM in 1 dose or 3 equally divided doses; Vancomycin 40 mg/kg per 24 h IV in 2–3 equally divided doses.

• Native valve endocarditis caused by relatively penicillin-resistant viridans group streptococci and Streptococcus bovis (MIC > 0.12 to ≤ 0.5 μg/mL)

• Preferred regimen (1): (Penicillin G 24 million U/24 h IV either continuously or in 4 or 6 equally divided doses for 4 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 4 weeks) AND Gentamicin 3 mg/kg per 24h IV/IM in 1 dose for 2 weeks.
• Preferred regimen (2): Vancomycin 30 mg/kg per 24 h IV in 2 equally divided doses not to exceed 2 g/24 h for 4 weeks.
• Pediatric dose: Penicillin G 200,000 U/kg per 24 h IV in 4–6 equally divided doses; Ceftriaxone 100 mg/kg per 24 h IV/IM in 1 dose; Gentamicin 3 mg/kg per 24 h IV/IM in 1 dose or 3 equally divided doses; Vancomycin 40 mg/kg per 24 h IV in 2–3 equally divided doses.

• Prosthetic valve endocarditis caused by highly penicillin-susceptible viridans group streptococci and Streptococcus bovis (MIC ≤ 0.12 μg/mL)

• Preferred regimen (1): (Penicillin G 24 million U/24 h IV either continuously or in 4 or 6 equally divided doses for 6 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 6 weeks) ± Gentamicin 3 mg/kg per 24h IV/IM in 1 dose for 2 weeks.
• Preferred regimen (2): Vancomycin 30 mg/kg per 24 h IV in 2 equally divided doses not to exceed 2 g/24 h for 6 weeks
• Pediatric dose: Penicillin G 200,000 U/kg per 24 h IV in 4–6 equally divided doses; Ceftriaxone 100 mg/kg per 24 h IV/IM in 1 dose; Gentamicin 3 mg/kg per 24 h IV/IM in 1 dose or 3 equally divided doses; Vancomycin 40 mg/kg per 24 h IV in 2–3 equally divided doses.

• Prosthetic valve endocarditis caused by relatively penicillin-resistant viridans group streptococci and Streptococcus bovis (MIC > 0.12 μg/mL)

• Preferred regimen (1): (Penicillin G 24 million U/24 h IV either continuously or in 4 or 6 equally divided doses for 6 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 6 weeks) AND Gentamicin 3 mg/kg per 24h IV/IM in 1 dose for 2 weeks.
• Preferred regimen (2): Vancomycin 30 mg/kg per 24 h IV in 2 equally divided doses not to exceed 2 g/24 h for 6 weeks
• Pediatric dose: Penicillin G 200,000 U/kg per 24 h IV in 4–6 equally divided doses; Ceftriaxone 100 mg/kg per 24 h IV/IM in 1 dose; Gentamicin 3 mg/kg per 24 h IV/IM in 1 dose or 3 equally divided doses; Vancomycin 40 mg/kg per 24 h IV in 2–3 equally divided doses.

• Staphylococcus

• Native valve endocarditis caused by oxacillin-susceptible staphylococci

• Preferred regimen (1): Nafcillin or Oxacillin 12 g/24 h IV in 4–6 equally divided doses for 6 wk ± Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 2 or 3 equally divided doses for 3–5 days.

• Preferred regimen (2): Cefazolin 6 g/24 h IV in 3 equally divided doses 6 wk ± Gentamicin sulfate3 mg/kg per 24 h IV/IM in 2 or 3 equally divided doses for 3–5 days.
• Pediatric dose: Nafcillin or Oxacillin 200 mg/kg per 24 h IV in 4–6 equally divided doses; Gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses; Cefazolin 100 mg/kg per 24 h IV in 3 equally divided doses; Gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses.

• Native valve endocarditis caused by oxacillin-resistant staphylococci

• Preferred regimen: Vancomycin 30 mg/kg per 24 h IV in 2 equally divided doses for 6 weeks.
• Pediatric dose: Vancomycin 40 mg/kg per 24 h IV in 2 or 3 equally divided doses.

• Prosthetic valve endocarditis caused by oxacillin-susceptible staphylococci

• Preferred regimen: Nafcillin or Oxacillin 12 g/24 h IV in 6 equally divided doses for ≥6 AND Rifampin 900 mg per 24 h IV/PO in 3 equally divided doses for ≥6 AND Gentamicin 3 mg/kg per 24 h IV/IM in 2 or 3 equally divided doses for 2 weeks.
• Pediatric dose: Nafcillin or Oxacillin 200 mg/kg per 24 h IV in 4–6 equally divided doses; Rifampin 20 mg/kg per 24 h IV/PO in 3 equally divided doses; Gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses.

• Prosthetic valve endocarditis caused by oxacillin-resistant staphylococci

• Preferred regimen: Vancomycin 30 mg/kg 24 h in 2 equally divided doses for ≥6 AND Rifampin 900 mg/24 h IV/PO in 3 equally divided doses ≥6 weeks AND Gentamicin 3 mg/kg per 24 h IV/IM in 2 or 3 equally divided doses for 2 weeks.
• Pediatric dose: Vancomycin 40 mg/kg per 24 h IV in 2 or 3 equally divided doses; Rifampin 20 mg/kg per 24 h IV/PO in 3 equally divided doses (up to adult dose); Gentamicin 3 mg/kg per 24 h IV or IM in 3 equally divided doses.

• Enterococcus

• Endocarditis caused by enterococcal strains susceptible to penicillin, gentamicin, and vancomycin

• Preferred regimen : (Ampicillin sodium 12 g/24 h IV in 6 equally divided doses for 4-6 weeks OR Aqueous crystalline penicillin G sodium 18–30 million U/24 h IV either continuously or in 6 equally divided doses for 4–6 weeks AND Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 3 equally divided doses for 4–6weeks.
• Alternative regimen : Vancomycin hydrochloride 30 mg/kg per 24 h IV in 2 equally divided doses for 6 weeks AND Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 3 equally divided doses for 6 weeks.
• Pediatric dose: Vancomycin 40 mg/kg per 24 h IV in 2 or 3 equally divided doses; Gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses

• Endocarditis caused by enterococcal strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin

• Preferred regimen : (Ampicillin sodium 12 g/24 h IV in 6 equally divided doses for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 million U/24 h IV continuously or in 6 equally divided doses for 4–6 weeks AND Streptomycin sulfate 15 mg/kg per 24 h IV/IM in 2 equally divided doses for 4–6 weeks.
• Alternative regimen : Vancomycin hydrochloride 30 mg/kg per 24 h IV in 2 equally divided doses for 6 weeks AND Streptomycin sulfate 15 mg/kg per 24 h IV/IM in 2 equally divided doses for 6 weeks.
• Pediatric dose: Ampicillin 300 mg/kg per 24 h IV in 4–6 equally divided doses; Penicillin 300 000 U/kg per 24 h IV in 4–6 equally divided doses; Streptomycin 20–30 mg/kg per 24 h IV/IM in 2 equally divided doses; Vancomycin 40 mg/kg per 24 h IV in 2 or 3 equally divided doses; Streptomycin 20–30 mg/kg per 24 h IV/IM in 2 equally divided doses.

• Endocarditis caused by enterococcal strains resistant to penicillin and susceptible to aminoglycoside and vancomycin

• Regimen for β-Lactamase–producing strain

• Preferred regimen: (Ampicillin-sulbactam 12 g/24 h IV in 4 equally divided doses for 6 weeks AND Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 3 equally divided doses for 6 weeks.
• Alternative regimen (2): Vancomycin hydrochloride 30 mg/kg per 24 h IV in 2 equally divided doses for 6 weeks.
• Pediatric dose: Ampicillin-sulbactam 300 mg/kg per 24 h IV in 4 equally divided doses; Gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses

• Regimen for Intrinsic penicillin resistance

• Preferred regimen: Vancomycin hydrochloride 30 mg/kg per 24 h IV in 2 equally divided doses for 6 weeks AND Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 3 equally divided doses for 6 weeks.
• Pediatric dose: Vancomycin 40 mg/kg per 24 h IV in 2 or 3 equally divided doses; Gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses

• Endocarditis caused by enterococcal strains resistant to penicillin, gentamicin, and vancomycin

• Enterococcus faecium

• Preferred regimen : [Linezolid]] 1200 mg/24 h IV/PO in 2 equally divided doses for ≥8 weeks OR Quinupristin-dalfopristin 22.5 mg/kg per 24 h IV in 3 equally divided doses for 8weeks.

• Enterococcus faecalis

• Preferred regimen (1): (Imipenem/cilastatin 2 g/24 h IV in 4 equally divided doses for ≥8 weeks AND Ampicillin sodium 12 g/24 h IV in 6 equally divided doses for ≥8 weeks OR Ceftriaxone sodium 4 g/24 h IV/IM in 2 equally divided doses for ≥8 weeks AND Ampicillin sodium 12 g/24 h IV in 6 equally divided doses for ≥8 weeks.
• Pediatric dose: Linezolid 30 mg/kg per 24 h IV/PO in 3 equally divided doses; Quinupristin-dalfopristin 22.5 mg/kg per 24 h IV in 3 equally divided doses; Imipenem/cilastatin 60–100 mg/kg per 24 h IV in 4 equally divided doses; Ampicillin 300 mg/kg per 24 h IV in 4–6 equally divided doses; Ceftriaxone 100 mg/kg per 24 h IV/IM in 2 equally divided doses.

• HACEK organisms

• Preferred regimen (1): (Ceftriaxone sodium 2 g/24 h IV/IM in 1 dose for 4 weeks OR Ampicillin- sulbactam 12 g/24 h IV in 4 equally divided doses for 4 weeks OR Ciprofloxacin 1000 mg/24 h PO or 800 mg/24 h IV in 2 equally divided doses for 4 weeks.
• Pediatric dose: Ceftriaxone 100 mg/kg per 24 h IV/IM once daily; Ampicillin-sulbactam 300 mg/kg per 24 h IV divided into 4 or 6 equally divided doses; Ciprofloxacin 20–30 mg/kg per 24 h IV/PO in 2 equally divided doses.

• Bartonella

• Suspected Bartonella endocarditis

• (table 14)

• Documented Bartonella endocarditis

• (table 14)

• Culture-negative endocarditis

• Culture-negative, native valve endocarditis

• (table 14)

• Culture-negative, prosthetic valve endocarditis (early, ≤ 1 year)

• (table 14)

• Culture-negative, prosthetic valve endocarditis (late, > 1 year)

• (table 14)

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• Lyme carditis

• Patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease

• Preferred oral regimens: Amoxicillin 500 mg 3 times per day for 14 days OR Doxycycline 100 mg twice per day for 14 days OR Cefuroxime 500 mg twice per day for 14 days
• Alternative oral regimens:
• Preferred parenteral regimens:
• Alternative parenteral regimens:

• Pediatric dose:

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• Mycotic aneurysm

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• Implantable electronic device infections

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• Pericarditis

• Bacterial pericarditis
• Histoplasmosis
• Extrapulmonary tuberculosis

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• Rheumatic fever

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• Cavernous sinus thrombosis

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• Intravenous line infections

• Intravenous line infections, non-tunneled
• Intravenous line infections, tunneled

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• Septic pelvic vein thrombophlebitis

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• Suppurative phlebitis

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• Ventricular-assist device infections