Cardiovascular system infections, antibacterial therapy Flashcards
Native Valve Endocarditis:
Q: What is the initial antibiotic treatment for native valve endocarditis?
A: Amoxicillin (or ampicillin). Consider adding low-dose gentamicin.
Q: What antibiotics should be used if a patient is penicillin-allergic, or if meticillin-resistant Staphylococcus aureus is suspected, or if there’s severe sepsis?
A: Use vancomycin + low-dose gentamicin.
Q: When should vancomycin + meropenem be used in native valve endocarditis?
A: It should be used if there’s severe sepsis with risk factors for Gram-negative infection.
Endocarditis (Native Valve) Caused by Staphylococci:
Q: What is the recommended initial treatment for native valve endocarditis caused by staphylococci?
A: Flucloxacillin. Suggested duration of treatment 4 weeks (at least 6 weeks if secondary lung abscess or osteomyelitis also present).
Q: What antibiotics should be used if a patient is penicillin-allergic or if there’s meticillin-resistant Staphylococcus aureus?
A: Use vancomycin + rifampicin.
Endocarditis (Prosthetic Valve) Caused by Staphylococci:
Q: What is the initial treatment for prosthetic valve endocarditis caused by staphylococci?
A: Flucloxacillin + rifampicin + low-dose gentamicin. Suggested duration of treatment at least 6 weeks; review the need to continue gentamicin at 2 weeks—seek specialist advice if gentamicin is considered necessary beyond 2 weeks.
Q: What antibiotics should be used in penicillin-allergic patients or if there’s meticillin-resistant Staphylococcus aureus?
A: Use vancomycin + rifampicin + low-dose gentamicin. Review the need to continue gentamicin at 2 weeks—seek specialist advice if gentamicin is considered necessary beyond 2 weeks.
Endocarditis Caused by Fully-Sensitive Streptococci:
Q: What is the initial antibiotic treatment for endocarditis caused by fully-sensitive streptococci?
A: Benzylpenicillin sodium. Suggested duration of treatment 4–6 weeks (6 weeks for prosthetic valve endocarditis).
Q: What antibiotics should be used if a patient is penicillin-allergic or there’s a need to stop gentamicin after 2 weeks?
A: Use vancomycin (or teicoplanin) + low-dose gentamicin.
Endocarditis Caused by Less-Sensitive Streptococci:
Q: What antibiotics are recommended for endocarditis caused by less-sensitive streptococci?
A: Benzylpenicillin sodium + low-dose gentamicin. Suggested duration of treatment 4–6 weeks (6 weeks for prosthetic valve endocarditis). Review the need to continue gentamicin at 2 weeks—seek specialist advice if gentamicin is considered necessary beyond 2 weeks. Stop gentamicin at 2 weeks if micro-organisms are moderately sensitive to penicillin.
Q: What should be used if a patient is penicillin-allergic or highly penicillin-resistant?
A: Use vancomycin (or teicoplanin) + low-dose gentamicin. Review the need to continue gentamicin at 2 weeks—seek specialist advice if gentamicin is considered necessary beyond 2 weeks. Stop gentamicin at 2 weeks if micro-organisms are moderately sensitive to penicillin.
Endocarditis Caused by Enterococci:
Q: What is the initial antibiotic treatment for endocarditis caused by enterococci?
A: Amoxicillin (or ampicillin) + low-dose gentamicin or benzylpenicillin sodium + low-dose gentamicin. Suggested duration of treatment 4–6 weeks (6 weeks for prosthetic valve endocarditis). Review the need to continue gentamicin at 2 weeks—seek specialist advice if gentamicin is considered necessary beyond 2 weeks.
Q: What should be used if gentamicin is resistant?
A: Use amoxicillin (or ampicillin). Add streptomycin (if susceptible) for 2 weeks. Suggested duration of treatment is at least 6 weeks.
Endocarditis Caused by HACEK Micro-Organisms:
Q: What is the recommended treatment for endocarditis caused by HACEK micro-organisms?
A: Amoxicillin (or ampicillin) + low-dose gentamicin. Suggested duration of treatment 4 weeks (6 weeks for prosthetic valve
Native Valve Endocarditis:
Q: What is the initial antibiotic treatment for native valve endocarditis?
A: Amoxicillin (or ampicillin). Consider adding low-dose gentamicin.
Q: What antibiotics should be used if a patient is penicillin-allergic, or if meticillin-resistant Staphylococcus aureus is suspected, or if there’s severe sepsis?
A: Use vancomycin + low-dose gentamicin.
Q: When should vancomycin + meropenem be used in native valve endocarditis?
A: It should be used if there’s severe sepsis with risk factors for Gram-negative infection.
Endocarditis (Native Valve) Caused by Staphylococci:
Q: What is the recommended initial treatment for native valve endocarditis caused by staphylococci?
A: Flucloxacillin. Suggested duration of treatment 4 weeks (at least 6 weeks if secondary lung abscess or osteomyelitis also present).
Q: What antibiotics should be used if a patient is penicillin-allergic or if there’s meticillin-resistant Staphylococcus aureus?
A: Use vancomycin + rifampicin.
Endocarditis (Prosthetic Valve) Caused by Staphylococci:
Q: What is the initial treatment for prosthetic valve endocarditis caused by staphylococci?
A: Flucloxacillin + rifampicin + low-dose gentamicin. Suggested duration of treatment at least 6 weeks; review the need to continue gentamicin at 2 weeks—seek specialist advice if gentamicin is considered necessary beyond 2 weeks.
Q: What antibiotics should be used in penicillin-allergic patients or if there’s meticillin-resistant Staphylococcus aureus?
A: Use vancomycin + rifampicin + low-dose gentamicin. Review the need to continue gentamicin at 2 weeks—seek specialist advice if gentamicin is considered necessary beyond 2 weeks.
Endocarditis Caused by Fully-Sensitive Streptococci:
Q: What is the initial antibiotic treatment for endocarditis caused by fully-sensitive streptococci?
A: Benzylpenicillin sodium. Suggested duration of treatment 4–6 weeks (6 weeks for prosthetic valve endocarditis).
Q: What antibiotics should be used if a patient is penicillin-allergic or there’s a need to stop gentamicin after 2 weeks?
A: Use vancomycin (or teicoplanin) + low-dose gentamicin.
Endocarditis Caused by Less-Sensitive Streptococci:
Q: What antibiotics are recommended for endocarditis caused by less-sensitive streptococci?
A: Benzylpenicillin sodium + low-dose gentamicin. Suggested duration of treatment 4–6 weeks (6 weeks for prosthetic valve endocarditis). Review the need to continue gentamicin at 2 weeks—seek specialist advice if gentamicin is considered necessary beyond 2 weeks. Stop gentamicin at 2 weeks if micro-organisms are moderately sensitive to penicillin.
Q: What should be used if a patient is penicillin-allergic or highly penicillin-resistant?
A: Use vancomycin (or teicoplanin) + low-dose gentamicin. Review the need to continue gentamicin at 2 weeks—seek specialist advice if gentamicin is considered necessary beyond 2 weeks. Stop gentamicin at 2 weeks if micro-organisms are moderately sensitive to penicillin.
Endocarditis Caused by Enterococci:
Q: What is the initial antibiotic treatment for endocarditis caused by enterococci?
A: Amoxicillin (or ampicillin) + low-dose gentamicin or benzylpenicillin sodium + low-dose gentamicin. Suggested duration of treatment 4–6 weeks (6 weeks for prosthetic valve endocarditis). Review the need to continue gentamicin at 2 weeks—seek specialist advice if gentamicin is considered necessary beyond 2 weeks.
Q: What should be used if gentamicin is resistant?
A: Use amoxicillin (or ampicillin). Add streptomycin (if susceptible) for 2 weeks. Suggested duration of treatment is at least 6 weeks.
Endocarditis Caused by HACEK Micro-Organisms:
Q: What is the recommended treatment for endocarditis caused by HACEK micro-organisms?
A: Amoxicillin (or ampicillin) + low-dose gentamicin. Suggested duration of treatment 4 weeks (6 weeks for prosthetic valve
