Aminoglycosides endocarditis

When aminoglycosides are used for endocarditis caused by gram-positive cocci with a traditional three-times daily regimen, peak serum concentrations are recommended to be on the low side of the traditional ranges (3 to 4 mcg/mL for gentamicin). 

ELISA) followed by Western blotting are used. As for treatment, doxicycline and rifampin for a minimum of six weeks. Ofloxacin plus rifampin is also effective. Therapy with rifampin, a tetracycline, and an aminoglycoside is indicated for infections with complications such as endocarditis or meningoencephalitis. 

Streptococcal Vancomycin is effective alone or in combination with an aminoglycoside for endocarditis caused by S. virldans or S. bovis. It is only effective in combination with an aminoglycoside for endocarditis caused by enterococci (eg, S. faecal Is). 

Diphtheroid-yancomyan is effective for diphtheroid endocarditis, and has been used successfully with rifampin, an aminoglycoside, or both in early onset prosthetic valve endocarditis caused by Staphylococcus epidermidls or diphtheroids. 

It is used in the treatment of severe anaerobic infections caused by bacteroides and other anaerobes. It is also used in combination with aminoglycoside in the treatment of abdomen and GIT wounds, infections of female genital tract, pelvic abscesses, aspiration pneumonia and septic abortion. It is also used for prophylaxis of endocarditis. It is also used along with primaquine in Pneumocystis carinii pneumonia in AIDS patients and with pyrimethamine for toxoplasmosis. 

Aminoglycosides are most useful for bacteraemias (especially Gram-negative septicaemia) since their volume of distribution is relatively low. With the exception of patients with renal failure or endocarditis they should be administered once-daily. This is because they exhibit a dose-dependent pharmacodynamic effect. This means that bactericidal activity is determined more by the peak plasma concentration than by the time that the plasma concentration is above the minimum required to achieve bacterial killing. The converse is true of p-lactams, which exhibit t/me-cfepenofent bacterial killing. 

Clindamycin is indicated for the treatment of skin and soft-tissue infections caused by streptococci and staphylococci. It is often active against community-acquired strains of methicillin-resistant S aureus, an increasingly common cause of skin and soft tissue infections. Clindamycin is also indicated for treatment of anaerobic infection caused by bacteroides and other anaerobes that often participate in mixed infections. Clindamycin, sometimes in combination with an aminoglycoside or cephalosporin, is used to treat penetrating wounds of the abdomen and the gut infections originating in the female genital tract, eg, septic abortion and pelvic abscesses and aspiration pneumonia. Clindamycin is now recommended rather than erythromycin for prophylaxis of endocarditis in patients with valvular heart disease who are undergoing certain dental procedures. Clindamycin plus primaquine is an effective alternative to trimethoprim-sulfamethoxazole for moderate to moderately severe Pneumocystis jiroveci pneumonia in AIDS patients. It is also used in combination with pyrimethamine for AIDS-related toxoplasmosis of the brain. 

The aminoglycosides include streptomycin, neomycin, kanamycin, amikacin, gentamicin, tobramycin, sisomicin, netilmicin, and others. They are used most widely against gram-negative enteric bacteria, especially in bacteremia and sepsis, in combination with vancomycin or a penicillin for endocarditis, and for treatment of tuberculosis. 

Other potentially nephrotoxic drugs (e.g, nonsteroidal antiinflammatory drugs) should be used with caution in patients receiving gentamicin therapy, Data for once-daily dosing of aminoglycosides for children exist, but no data for treatment of infective endocarditis exist. 

Optional addition of gentamicin sulfate 3 mg/kg per 24 hours IV/IM in two or three equally divided 3-5 days infective endocarditis for uncomplicated right-sided infective endocarditis, 2 weeks Clinical benefit of aminoglycosides has not been established... 

Bacterial endocarditis. An aminoglycoside, usually gentamicin, should comprise part of the antimicrobial combination for enterococcal, streptococcal or staphylococcal infection of the heart valves, and for the therapy of clinical endocarditis which fails to yield a positive blood culture. 

Tam VH, Preston SL, Briceland LL. Once-daily aminoglycosides in the treatment of Gram-positive endocarditis. Ann Pharmacother 1999 33(5) 600-6. 

Aminoglycosides are parenteral antibiotics most widely used in the treatment of infections due to enteric gramnegative bacteria. However, aminoglycosides are often used in combination with cell wall-active agents such as beta-lactams or vancomycin for treatment of endocarditis. Aminoglycosides initially diffuse passively across the baae-rial outer membrane and are then actively transported into the cytoplasm. This active transport is inhibited in low pH or anaerobic conditions. Once inside the cytoplasm, aminoglycosides inhibit protein synthesis by binding to the bacterial... 

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