CV SYSTEM INFECTIONS

Question 1

What do you give as
“blind” therapy to a patient with a native heart valve and has endocarditis?

Answer 1

1. Amoxicillin (or ampicillin) - May consider adding low-dose gentamicin
2.penicillin allergy/MRSA = vancomycin + low dose gentamicin
3.Staphlococci = flucloxacillin for 4 weeks, if penicillin allergy/ MRSA= vancomycin + rifampicin for 4 weeks

Question 2

What do you give as
“blind” therapy to a patient with a prosthetic heart valve and has endocarditis?

Answer 2

1.Vancomycin + rifampacin +
low-dose Gentamicin
2.Staphlococci = flucloxacillin + rifampicin + low dose gentamicin (at least 6 weeks, review gentamicin after 2)
3.Penicillin allergy/MRSA= Vancomycin + Rifampacin + Low-dose Gentamicin

Question 3

How do you treat
Endocarditis caused by fully-sensitive streptococci?

Answer 3

1. Benzylpenicillin (Penicillin G)
   - For 4-6 weeks (6 weeks if prosthetic valve)
   If penicillin-allergic:
   Vancomycin (or Teichoplanin)
   + Low-dose Gentamicin
   - For 4-6 weeks (Stop gentamicin after 2 weeks)

Question 4

How do you treat
Endocarditis caused by less-sensitive streptococci?

Answer 4

1. Amoxicillin (or ampicillin) +Low dose Gentamicin
   OR
2. Benzylpenicillin + Low-dose Gentamicin
   - For 4-6 weeks (6 weeks for prosthetic valve)
   - Stop Gentamicin after 2 weeks
   If Penicillin-allergic or penicillin resistant:
   * Vancomycin + Low-dose Gentamicin
   - For 4-6 weeks (6 weeks prosthetic valve)
   - Stop Gentamicin after 2 weeks

Question 5

If patients have
endocarditis caused by enterococci and are gentamicin resistant, what do you do?

Answer 5

1. Amoxicillin (or Ampicillin) +
   Streptomycin
   - For 6 weeks
   - Streptomycin given for 2 weeks

Question 6

How long is the treatment for native or prosthetic heart valve endocarditis?

Answer 6

4 weeks for native
6 weeks for prosthetic

Question 7

If penicillin-allergic, what is usually given in Endocarditis?

Answer 7

Vancomycin + Low-dose
Gentamicin

Question 8

What are HACEK micro-organisms?

Answer 8

H: Haemophilus
A: Actinobacillus
C: Cardiobacterium
E: Eikenella
K: Kingella

Question 9

How do you treat
Endocarditis caused by HACEK organisms?

Answer 9

1. Amoxicillin (or ampicillin) +
   Low-Dose Gentamicin
   - 4-6 weeks (6 weeks if prosthetic valve)
   - Stop Gentamicin after 2 weeks
   If amoxicillin-resistant:
   Ceftraixone (or Cefotaxime) +
   Low-dose Gentamicin
   - For 4-6 weeks
   - Stop Gentamicin after 2 weeks

Question 10

How long can
Gentamicin be taken in Endocarditis?

Answer 10

Max 2 weeks
Any longer requires specialist intervention