Endocarditis vancomycin

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

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. 

Streptococcal Vancomycin is effective alone or in combination with an aminoglycoside for endocarditis caused by S. virldans or S. bovis. It is only effective in combination with an aminoglycoside for endocarditis caused by enterococci (eg, S. faecal Is). 

Prop/ y/acf/c-Although no controlled clinical efficacy studies have been conducted, IV vancomycin has been suggested for prophylaxis against bacterial endocarditis in penicillin-allergic patients who have congenital... 

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... 

Teicoplanin, although not available in the United States, has been used to treat a wide range of gram-positive infections, including endocarditis and peritonitis. It is not as effective as the (3-lactams, but its actions are similar to those of vancomycin against staphylococcal infections. 

Daptomycin Binds to cell membrane, causing depolarization and rapid cell death Bactericidal activity against susceptible bacteria more rapidly bactericidal than vancomycin Infections caused by grampositive bacteria including sepsis and endocarditis IV administration renal clearance (half-life 8 h) dosed once daily inactivated by pulmonary surfactant so cannot be used to treat pneumonia Toxicity Myopathy monitoring of weekly creatine phosphokinase levels recommended... 

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. 

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... 

Rifampin is used in a variety of other clinical situations. An oral dosage of 600 mg twice daily for 2 days can eliminate meningococcal carriage. Rifampin, 20 mg/kg/d for 4 days, is used as prophylaxis in contacts of children with Haemophilus influenzae type b disease. Rifampin combined with a second agent is used to eradicate staphylococcal carriage. Rifampin combination therapy is also indicated for treatment of serious staphylococcal infections such as osteomyelitis and prosthetic valve endocarditis. Rifampin has been recommended also for use in combination with ceftriaxone or vancomycin in treatment of meningitis caused by highly penicillin-resistant strains of pneumococci. 

Answer B (Amoxicillin). The multiple extractions can lead to bacteremia while the mitral valve stenosis and cardiac insufficiency place him at risk for developing endocarditis. The present American Heart Association guidelines indicate amoxicillin (3 gm 1 hour prior to procedure and 1.5 gm 6 hours after original dose.) Vancomycin would only be appropriate if the patient was allergic to penicillins. Tetracycline and cotrimoxazole are bacteriostatic and not effective against the viridans group of Streptococci, the usual causative organism. Imipenem is also inappropriate since its spectrum is too broad. 

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. 

Daptomycin has proven efficacy in a number of in vivo animal models, including soft tissue infections by MRSA, bacteraemia caused by S. aureus or vancomycin-resistant enterococci (VRE), Enterococcus faecalis pyelonephritis, MRSA osteomyelitis, MRSA and Bacillus anthracis pulmonary infections, Gram-positive endocarditis, Clostridium difficile colitis and S. pneumoniae and S. aureus meningitis.9,64 66... 

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

Staphylococcal septicaemia may be suspected where there is an abscess, e.g. of bone or lung, or with acute infective endocarditis or infection of intravenous catheters high dose flucloxacillin is indicated (vancomycin). 

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. 

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). 

---