Gentamicin endocarditis

Therapy for Native-Valve or Prosthetic-Valve Enterococcal Endocarditis Caused by Strains Susceptible to Penicillin, Gentamicin, and Vancomycin... 

Ceftriaxone sodium plus Gentamicin sulfate 2 g/24 hours IV/IM in one dose 4 IB cal endocarditis (see Table 37-8)... 

Enterococcal endocarditis ordinarily requires 4 to 6 weeks of high-dose penicillin G or ampicillin, plus gentamicin for cure (Table 37-8). A 6-week course is recommended for patients with symptoms lasting longer than 3 months and those with PVE. 

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). 

Empiric treatment for subacute endocarditis likely to be caused by penicillin-sensitive streptococci consists of high dose penicillin G (6 x 3 million units i.v. daily) plus gentamicin (1x3 mg/kg). In acute endocarditis a staphylococcal etiology is more likely and, therefore, gentamicin is combined with (flu)cloxacillin (6 x 2 g i.v. daily). 

Vancomycin is also an effective alternative therapy for the treatment of staphylococcal enterocolitis and endocarditis. The combination of vancomycin and either streptomycin or gentamicin acts synergisticaUy against enterococci and is used effectively for the treatment or... 

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. 

Penicillin plus streptomycin is effective for enterococcal endocarditis and 2-week therapy of viridans streptococcal endocarditis. Gentamicin has largely replaced streptomycin for these indications. Streptomycin remains a useful agent for treating enterococcal infections, however, because approximately 15% of enterococcal isolates that are resistant to gentamicin (and therefore to netilmicin, tobramycin, and amikacin) will be susceptible to streptomycin. 

Gram-positive cocci Enterococcus faecalis Endocarditis or other serious infection (bacteremia] Ampicillin or penicillin G + gentamicin or streptomycin Vancomycin + gentamicin or streptomycin... 

Staphylococcus aureus Abscesses bacteremia cellulitis endocarditis osteomyelitis pneumonia others If methicillin-sensitive nafcillin or oxacillin If methicillin-resistant vancomycin gentamicin or rifampin 1 st-generation cephalosporin clindamycin erythromycin trimethoprim-sulfamethoxazole a penicillin + a penicillinase inhibitor... 

Streptococcus (viridians group) Bacteremia endocarditis Penicillin G gentamicin Ist-generation cephalosporin erythromycin azithromycin clarithromycin vancomycin gentamicin... 

This patient was treated empirically with vancomycin alone because his physicians suspected that he had endocarditis, caused by Streptococcus of the viridans group. The history indicated that the origin of the infection was the patient s mouth. Three days later the results from the clinical microbiology laboratory showed that three blood cultures, taken at the time of admission, grew Enterococcus faecalis. susceptible to ampicillin, vancomycin, gentamicin, and streptomycin. 

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... 

Getttamidtt. Gentamicin is widely used in the treatment of severe infections. Uses include septicemia, neonatal sepsis, neonatal meningitis, biliary tract infection, pyelonephritis, prostatitis, and endocarditis. Gentamicin is frequently used for empiric therapy in presmned gramnegative bacillary infections before the identification and susceptibility of the causative organism are known. Patients with cystic fibrosis and those in intensive care imits often have Pseudomonas infections and are typically treated with gentamicin. 

To obtain potentiation (or synergy ), i.e. an effect unobtainable with either drug alone, e.g. penicillin plus gentamicin for enterococcal endocarditis. 

Strepiococcus, v, rrduns group (endocarditis) benzylpenicillin gentamicin vancomycin or a cephalosporin... 

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. 

Culture-negative endocarditis benzylpenicillin plus gentamicin i.v. are given for 4r-6 weeks. 

Special risk patients, i.e. with prosthetic valves or with previous endocarditis, should receive amoxicillin 1 g i.m. or i.v. and gentamicin 120 mg at induction, then amoxicillin 0.5 g by mouth 6 h later. Patients who are penicillin-allergic or have received penicillin more that once in the previous month should receive vancomycin 1 g i.v. over 100 min then gentamicin 120 mg i.v. at induction or 15 min before the procedure or teicoplanin 400 mg i.v. plus gentamicin 120 mg i.v, at induction or 15 min before the procedure or clindamycin 300 mg over at least 10 min at induction or 15 min before the procedure then clindamycin 150 mg i.v. or by mouth 6 h later. 

Tablan OC, Reyes MP, Rintelmann WF, lerner AM. Renal and auditory toxicity of high-dose, prolonged therapy with gentamicin and tobramycin in Pseudomonas endocarditis. J Infect Dis 1984 149(2) 257-63. 

Infective endocarditis is a serious complication of centrally placed venous access devices. The successful treatment in situ of a large thrombus associated with the tip of the catheter has been described (29). The antibiotic regimen was gentamicin and vancomycin, both delivered via the venous access device vancomycin was allowed to remain in situ between each 8-hourly dosing. This regimen successfully eradicated the thrombus within 3 weeks, without removal of the hue. 

Tablet-associated esophagitis has been reported in a 70-year-old white man on the fourth day of antibiotic therapy with vancomycin, gentamicin, and oral rifampicin for Staphylococcus epidermidis prosthetic valve endocarditis (50). 

In a prospective, randomized trial in 34 drug abusers a short course of a combination of a glycopeptide (vancomycin or teicoplanin) with gentamicin was significantly less effective in right-sided endocarditis caused by S. aureus than a combination of cloxacilhn and gentamicin (9). 

Fortun J, Navas E, Martinez-Beltran J, Perez-Molina J, Martin-Davila P, Guerrero A, Moreno S. Short-course therapy for right-side endocarditis due to Staphylococcus aureus in drug abusers cloxacilhn versus glycopeptides in combination with gentamicin. Clin Infect Dis 2001 33(l) 120-5. 

Vancomycin-associated thrombocytopenia has been reported in a 72-year-old woman who was treated with gentamicin and vancomycin for infectious endocarditis due to Clostridium pseudodiphtheriticum (52). On the 4th day of treatment, the platelet count fell and reached a nadir of 14 x lO /l on day 7. Two days after withdrawal of vancomycin (day 8) the platelet count began to rise and reached 150 x lO /l within 5 days. Vancomycin-dependent antiplatelet IgG antibodies were not detected 10 days after vancomycin. 

---