Antimicrobial therapy endocarditis

Baddour LM, Wilson WR, Bayer AS, et al. 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 2005 111(23) 394M34. 

Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis Diagnosis, antimicrobial therapy, and management of complications. American Heart Association scientific statement. Circulation 2005 111 e394—433. 

After 12 months, the likely organism for PVE parallels that of native-valve endocarditis. As with native-valve endocarditis, antimicrobial therapy should be based on the identified organism and... 

Korzeniowski O, Sande MA. The National Collaborative Endocarditis Study Group Combination antimicrobial therapy for Staphylococcus aureus endocarditis in patients addicted to parenteral drugs and in nonaddicts. Ann Intern Med 1982 97 496-503. 

Parker RH, Fossieck BE. Intravenous followed by oral antimicrobial therapy for staphylococcal endocarditis. Ann Intern Med 1980 93 832-834. 

An optimal procedure for management of such infections has yet to be defined. Usually the management consists in antimicrobial therapy combined with complete device removal. However, mortality rates of device-related endocarditis remain as high as 18%. ° ... 

For parenteral therapy, nafciUin and oxacillin offer comparable efficacy and antimicrobial spectra of activity. Although both drugs undergo hepatic metabolism, only nafcillin requires dose adjustment in patients with combined hepatic and renal insufficiency. Other pharmacokinetic data for nafcillin and oxacillin appear in Table 45.1. Indications for nafcillin or oxacillin include severe staphylococcal infections like cellulitis, empyema, endocarditis, osteomyelitis, pneumonia, septic arthritis, and toxic shock syndrome. 

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. 

Antimicrobial combination therapy is used frequently to treat serious infections. Combination therapy may be used prior to knowing the pathogen or antibiotic susceptibility for the treatment of infections in neutropenic patients and in patients with enterococcal endocarditis or bacteremia, sepsis, or pneumonia caused by P. aeruginosa. In these cases, it is important to know whether the combination will have beneficial (or detrimental) effects on the overall antibacterial activity of the regimen. For example, the combination may result in activity that is... 

The proper route of administration for an antimicrobial depends on the site of infection. Parenteral therapy is warranted when patients are being treated for febrile neutropenia or deep-seated infections such as meningitis, endocarditis, and osteomyelitis. Severe pneumonia often is treated initially with intravenous antibiotics and switched to oral therapy as clinical improvement is evident. Patients treated in the ambulatory setting for upper respiratory tract infections (e.g., pharyngitis, bronchitis, sinusitis, and otitis media), lower respiratory tract infections, skin and soft tissue infections, uncomplicated urinary tract infections, and selected sexually transmitted diseases may receive oral therapy. 

All enterococci causing endocarditis must be tested for antimicrobial susceptibility in order to select optimal therapy (see text). This table is for endocarditis due to gentamicin- or vancomycin-susceptible enterococci, viridans streptococci with a minimum inhibitory concentration of >0.5 mcg/mL, nutritionally variant viridans streptococci, or prosthetic valve endocarditis caused by viridans streptococci or Streptococcus bovis. Antibiotic dosages are for patients with normal renal function. 

Lee BL. Chambers HE, Novak RM, Rodvold KA, Kaatz G, Rybak M, McCloskey R, Zecicel M. TKerasse D. Daptomycin versus conventional therapy in the treatment of endocarditis (E) and bacteremia (B). Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy, 1991 A885. 

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