Infective endocarditis antibiotics

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... 

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. 

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

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... 

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. 

From Wilson WR, Karchmer AW, Dajani AS, etal. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, and staphylococci, and HACEK microorganisms. JAMA 1995 274 1706-1713, with permission. Copyright 1995-1997, American Medical Association. 

Torres-Tortosa M, de Cueto M, Vergara A, et al. Prospective evaluation of a two-week course of intravenous antibiotics in intravenous drag addicts with infective endocarditis. Eur J CUn Microbiol Infect Dis 1994 13 559-564. 

Prior to 1997, erythromycin was an alternative antibiotic choice to amoxicillin for prophylaxis prior to dental, oral, esophageal, and respiratory procedures to prevent infective endocarditis (IE). Erythromycin is an alternative choice for treating a recurrence of acute rheumatic fever in patients allergic to penicillin [12]. Recently updated recommendations by the American Heart Association for IE... 

Inadequately treated infections are frustrating and expensive to treat when they recur. Successful therapy regimens range from outpatient therapy with oral antibiotics (e.g., otitis media) to weeks of hospitalization with IV antibiotics (e.g., infective endocarditis). Both the patient and the physician will pay for shortcuts. 

Used in combination with other antibiotics to treat staphylococcal infections, endocarditis, tuberculosis, pelvic inflammatory disease... 

According to Franz et al. (1997), patients should be treated with combinations of antibiotics because treatment with a single antibiotic causes poor response or relapse. Usually, a combination of doxycycline and rifampin is given orally for six weeks. Trimethoprim-sulfamethoxazole can be substituted for rifampin, although relapse rates may be as high as 30 percent (Franz et al., 1997). The recommended treatment for bone and joint infections, endocarditis, and central nervous system disease is streptomycin or another aminoglycoside, and therapy should be extended. 

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... 

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... 

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... 

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