CV infection

Question 1

initial blind therapy for endocarditis, native valve endocarditis

Answer 1

amox or ampicillin
consider + gentamicin low dose

if penicillin allergic or MRSA, or severe sepsis: vancomycin + low dose gentamicin

if severe sepsis with RF for gram negative infection: vancomycin + meropenem

Question 2

initial blind therapy for prosthetic valve endocarditis

Answer 2

vancomycin + rifampicin + low dose gentamicin

Question 3

treatment and duration for endocarditis (native valve) caused by staphylococci

Answer 3

fluclox, 4 weeks (at least 6 weeks if secondary lung abscess or osteomyelitis also present)

if allergic or MRSA: vancomycin + rifampicin 4 weeks, (6 as above)

Question 4

treatment and duration for endocarditis caused by fully-sensitive streptococci

Answer 4

1. benzylpenicillin 4-6 weeks (6 for prosthetic valve endocarditis)

allergic: vancomycin (or teicoplanin) + low dose gentamicin 4-6 weeks (stop gentamicin after 2 weeks)

Question 5

treatment and duration of endocarditis caused by less-sensitive streptococci

Answer 5

1. benzylpenicllin + low dose gentamicin

if allergic or highly resistant: vancomycin or teicoplanin + low dose gentamicin

Question 6

peak and trough for gentamicin in endocarditis

Answer 6

peak 3-5
trough <1

Question 7

treatment of endocarditis caused by enterococci

Answer 7

amox (or ampicillin) + low dose gentamicin OR benzylpenicllin + low dose gentamicin

Question 8

treatment of endocarditis caused by Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella species (‘HACEK’ micro-organisms)

Answer 8

1. amox (or ampicillin) + low dose gentamicin 4 weeks

if amox resistant: ceftriaxone (or cefotaxmine) + low dose gentamicin