Gentamicin Vancomycin

Unknown Piperacillin or ceftazidime/cefepime or imipenenYmeropenem + gentamicin vancomycin... 

Subacute Viridans streptococci, enterococci Penicillin + gentamicin Vancomycin + gentamicin... 

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

Renal elimination Elimination of gentamicin, vancomycin, cephalosporins less than predicted by serum creatinine ... 

Antibiotic resistance behaviour of 308 enterococci isolated from Bryndza cheese is shown in Fig. 5. All enterococcal isolates from Bryndza cheese were susceptible to ampicillin, streptomycin, gentamicin, vancomycin, and teicoplanin. For these same isolates, resistance rates to rifampicin, erythromycin, ciprofloxacin, and... 

Figures 6-8 illustrate antibiotic resistance patterns of E. faecium, E. faecalis, and E. durans isolates from Bryndza cheese. No one of the E. faecium, E. durans, and E. faecalis isolates were resistant to ampicillin, streptomycin, gentamicin, vancomycin, and teicoplanin. Thirty six percent of the E. faecium isolates and 22% of the E. faecalis isolates were resistant to erythromycin. E. faecium showed similar resistance to rifampicin (31%) as E. faecalis (29%). Both E. faecium and E. faecalis strains exhibited the same resistance to ciprofloxacin (2%). E. durans isolates showed very low level of resistance to rifampicin, erythromycin, ciprofloxacin, and nitrofurantoin (1 %). E. faecium, E. faecalis and E. durans were also found to be the predominant species recovered from naturally ripened European cheeses and...

Enterococcus faecalis Penicillin G plus gentamicin Vancomycin plus gentamicin... 

If no adequate dosage form is available, it is possible to use oral liquids rectally, eye drops in the ear or a sometimes costly injectable solution orally (e.g. clonidine) and, less frequently, by respiratory routes (e.g. gentamicin, vancomycin). Doses may need to be adapted due to differing... 

Tobramycin, gentamicin Amikacin Vancomycin 10-12 30-40 C Less than 1.5 Less than 5.0 10-15 21.4-25.7 35.1-46.8 C Less than 3.2 Less than 5.85 7-10.35... 

Empiric antibiotic coverage for gram-positive, gram-negative, and Enterococcus (e.g., gentamicin plus vancomycin, then individualize after culture results become available) continue for 2-4 weeks... 

Patients with PVE caused by penicillin-susceptible strains of viridans streptococci require treatment for 6 weeks with penicillin G or ceftriaxone with or without gentamicin during the initial 2 weeks of therapy. However, if the organism demonstrates less susceptibility to penicillin (MIC greater than 0.12 mcg/mL), a combination therapy with penicillin G or ceftriaxone plus gentamicin should be given for the entire 6 weeks. Vancomycin remains the primary alternative if the patient is allergic to (l-lactams (e.g., penicillins, cephalosporins, etc.). 

It is important to determine (1) whether the isolate is methicillin-susceptible or methicillin-resistant and (2) whether the patient has a prosthetic valve. For patients with no prosthetic material, methicillin-susceptible staphylococci treatment should consist of a penicillinase-resistant penicillin (e.g., nafcillin or oxacillin) with or without gentamicin, and for methicillin-resistant strains, therapy should consist of vancomycin (see Table 71-4). Combination therapy with aminoglycosides, when used in these patients, typically is given only during the first 3 to 5 days of therapy. In the absence of prosthetic material, some treatment guidelines do not recommend combination therapy against MRSA. However, many clinicians may combine either gentamicin or rifampin with vancomycin if the patient is unresponsive to monotherapy. 

For staphylococcal PVE, treatment length increases significantly, typically requiring a minimum of 6 weeks (see Table 71-5). For MSSA, a penicillinase-resistant penicillin is still employed, as well as vancomycin for MRSA. However, with either regimen, the addition of both gentamicin for first 2 weeks and rifampin for the entire length of treatment is recommended. 

For enterococci, it is imperative to determine species and antibiotic susceptibilities. If the organism is susceptible to penicillin and vancomycin, treatment may consist of high-dose penicillin G, ampicillin, or vancomycin plus gentamicin (see Table 71-6). Treatment length is usually 4 to 6 weeks, with the aminoglycoside used over the entire course. As resistance develops to penicillin, ampicillin and vancomycin remain treatment options. Once the isolate becomes resistant to ampicillin, vancomycin is considered the treatment of choice. 

Gentamicin should be administered in close proximity to vancomycin, nafcillin, or oxacillin dosing. cPediatric dose should not exceed that of a normal adult. 

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

Evaluate therapeutic serum drug concentrations as appropriate (e.g., vancomycin and gentamicin). 

A 43-year-old male in the surgical ICU after exploratory laparotomy following a motor vehicle accident develops fever that is unresponsive to broad-spectrum antibacterial therapy (piperacillin-tazobactam 3.75 g every 6 hours, gentamicin 120 mg every 8 hours, and vancomycin 1 g every 12 hours). The patient has a central venous catheter and a Foley catheter. Blood cultures are negative at the time, but the patient has yeast growing in the sputum and urine. Laboratory studies reveal a white blood cell count of 11,300 cells/mm3 (11.3 x 109/L). 

Vancomycin + (gentamicin or streptomycin), linezolid, daptomycin, tigecydine Urinary tract infection (UTI)... 

FCC,b c trimethoprim-sulfamethoxazole, clindamycin ampidllin-sulbadam, or amoxidllinresistant Vancomycin (gentamicin or rifampin)... 

TGQc i erythromydn, azithromycin, clarithromycin,h or vancomycin gentamicin Gram-negative corn... 

Vancomycin hydrochlo- Pediatic dose penicillin 200,000 units/kg per 24 hours IV in four to six equally divided doses ceftriaxone 100 mg/kg per 24 hours IV/IM in one dose gentamicin 3 mg/kg per 24 hours IV/IM in one dose or three equally divided doses 30 mg/kg per 24 hours IV in two equally divided doses not to exceed 2 g/ 4 1 B (second option to single daily dose) Vancomycin therapy recommended only for patients unable to tolerate... 

Vancomycin is effective and is the drug of choice for the patient with a history of immediate-type hypersensitivity reaction to penicillin. When vancomycin is used, the addition of gentamicin is not recommended. 

Penicillin G 24 million units/24 h IV in four to six equally divided doses may be used in place of nafcillin or oxacillin if strain is penicillin susceptible (minimum inhibitory concentration <0.1 mcg/mL) and does not produce/ lactamase. cGentamicin should be administered in close temporal proximity to vancomycin, nafcillin, or oxacillin dosing See Table 37-3 for appropriate dosage of gentamicin. 

In addition to isolates with high-level aminoglycoside resistance, /3-lacta-mase-producing enterococci (especially Enterococcus faecium) are increasingly reported. If these organisms are discovered, use of vancomycin or ampicillin-sulbactam in combination with gentamicin should be considered. 

Gentamicin 3 mg/kg per 24 hours IV/IM in two orlhree equally divided doses Pediatric dose vancomycin 40 mg/kg per 24 hours IV in two or three 2 ... 

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