Endocarditis antibiotics

Infections of AVF are less frequent than CLABSI, and usually occur at the cannulation site. Vascular surgeons should evaluate the AVF to determine the need for surgical resection. Regardless, these infections should be treated for 6 weeks, in analogy to subacute bacterial endocarditis. Antibiotic therapy should be guided by culture results and resistance profiles. AVG infections usually require surgical revision with either partial, subtotal or total excision of the graft. 

Antimicrobials also can be classified as possessing bactericidal or bacteriostatic activity in vitro. Bactericidal antibiotics generally kill at least 99.9% (3 log reduction) of a bacterial population, whereas bacteriostatic antibiotics possess antimicrobial activity but reduce bacterial load by less than 3 logs. Clinically, bactericidal antibiotics may be necessary to achieve success in infections such as endocarditis or meningitis. A full discussion of the application of antimicrobial pharmacodynamics is beyond the scope of this chapter, but excellent sources of information are available.15... 

Infective endocarditis caused by these streptococci typically has a subacute clinical course. The current cure rate is often over 90% unless complications occur, which is the case in more than 30% of patients.17 The majority of viridans streptococci remain very susceptible to penicillin, with most strains having a minimum inhibitory concentration (MIC) of less than 0.125 mcg/mL.15,18 Organisms with decreased susceptibilities are increasing. Therefore, antibiotic susceptibilities need to be assessed in order to determine the most appropriate treatment regimen. 

Resolution of infective endocarditis syndrome with antibiotic therapy for less than or equal to 4 days, or... 

Fungal endocarditis is quite uncommon but has significant mortality, typically affecting patients who have had cardiovascular surgery, received a prolonged course of broad-spectrum antibiotics, have long-term catheter placement, are immunocompromised, or are IVDUs.8,35 Survival rates have remained... 

Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of CHD Prophylaxis is recommended because endothelialization of prosthetic material occurs within 6 months after the procedure From Wilson W, TaubertFA, CewilzM,etaL Prevention of infective endocarditis. Grculalion 2007 116 1736-1754 with permission Copyright 2007, American Medical Association. 

Treatment — Various antibiotics are useful in treating Coxiella infections. They include tetracycline, doxycycline, and erythromycin. In cases of endocarditis, treatments with doxycycline combined with rifampin, and trimethoprim-sulfamethoxazole combined with doxycycline or tetracycline for 12 months or longer have been successful.3... 

Even newer is the natural product daptomycin (Cubicin), a complex cyclic lipopeptide structure, approved for use in the United States in 2003. Daptomycin has a spectrum similar to that of linezolid and specifically includes MRSA and VRE. In contrast to linezolid, daptomycin is bactericidal for these Gram-positive organisms. It is, like vancomycin, a parenteral antibiotic and is given intravenously. It is indicated for treatment of complicated skin and skin structure infections and for some cases of bacteremia, including endocarditis. Daptomycin may be thought of as an alternative to vancomycin. 

Various antimicrobials agents is used in dentistry for prevention of local oral wound infection and prevention of distant infection i.e., bacterial endocarditis. Generally, prophylaxis by the use of antibiotics is not required for routine type of dental surgery... 

It is used in all forms of tuberculosis along with other antitubercular drugs. Other indications are tularemia, plague, brucellosis, bacterial endocarditis, entero-coccal endocarditis. Used concomitantly with penicillin G for synergistic effect in the treatment of enterococcal endocarditis when other antibiotics are ineffective or contraindicated. 

Le T, Bayer AS Combination antibiotic therapy for infective endocarditis. Clin Infect Dis 2003 36 615. [PMID 12594643]... 

Approximately 25% of all patients with hypertrophic cardiomyopathy (HCM) have latent left ventricular outflow obstruction with an intraventricular gradient (I). Pathophysiologic features are asymmetric hypertrophy of the septum and a systolic anterior movement of the anterior leaflet. Medical treatment includes betablockers, and calcium antagonists of the verapamil type. Approximately 5— 10% of the patients with outflow obstruction are refractory to such negative inotropic therapy (2). Positive inotropic drugs such as digitalis or sympathomimetics are strictly contraindicated. In the presence of atrial fibrillation, anticoagulation therapy should be started. Since endocarditis is more common in patients with HCM because of turbulence in the left ventricle, prophylactic antibiotics should be administered for periods of potential bacteraemia. 

Intravenous antibiotics are given before and after the procedure. Five thousand to ten thousand units of heparin should be administered after transseptal puncture. Aspirin (100-300 mg/day, p.o.) and clopidogrel (75 mg/day, p.o.) is prescribed for the following six months as well as endocarditis prophylaxis. A TEE is performed at six months. If the LAA is completely occluded, no further anticoagulation is required. 

Intravenous antibiotics are given before and after the procedure. Endocarditis prophylaxis is recommended for six months. Coumadin type drugs should be administered at least for 45 days after the Watchman implantation procedure with an INR between two and three in combination with 100 mg aspirin. When complete endothelialization is likely with no or only little flowthrough the device, coumadin can be discontinued and clopidogrel 75 mg/day is given until six months follow-up examination. In the absence of thrombus or flow in the appendage at TEE at six months, clopidogrel is stopped and aspirin therapy 100 mg/day is continued indefinitely If thrombus formation is seen, obviously coumadin therapy is restarted. 

Question A.14 Assuming that the patient is suffering from endocarditis due to Streptococci, what antibiotic would be appropriate to employ empirically before the etiological organism was identified ... 

Daptomycin is an important antibiotic approved for the treatment of complicated skin and skin structure infections caused by Gram-positive pathogens1 and for treatment of bacteraemia, including right-sided endocarditis caused by Staphylococcus aureus strains, including those resistant to methicillin (MRSA).2... 

Early institution of the correct antibiotic therapy is the most effective way to prevent thromboembolism in infective endocarditis, the risks of which are highest in the first... 

The administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients who undergo GI tract procedures, including diagnostic esophagogastroduodenoscopy or colonoscopy, as recommended by American Heart Association 2007 guidelines. 

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