Endocarditis

Question 1

Risk Factors

Answer 1

-Previous endocarditis
-Prosthetic valve
-Cardiac device (pacemaker)
-Invasive dental work

Question 2

Diagnosis

Answer 2

Definite IE
-Clinical criteria of 2 major OR 1 major and 3 minor OR 5 minor

Major: pos blood culture, surgery/imaging

Minor: PD, fever, phenomena, microbio, PE, imaging

Question 3

Prevention of IE

Answer 3

for dental procedures which are high risk

single dose prior
1. amoxicillin 2 g PO
2. PCN allergy: cephalexin 2g PO

Question 4

Duration

Answer 4

4-6 weeks
*long bc of high bacterial densities

first day of negative blood culture is day 1 of tx

Question 5

Strep, Native valve (3 MICs)

Answer 5

MIC < 0.12
-Ceftriaxone 2 g QD
-Alt: PCN G 12-18 mil QD

MIC 0.12-0.5
-PCN G 12-18 mil QD for 4 wk + Gent 3 mg/kg QD for 2 wk
-Alt: Ceftriaxone 2 g QD

MIC > 0.5
-PCN G 12-18 mil QD for 4 wk + Gent 3 mg/kg QD for 2 wk

PG Thirteen

Question 6

Strep, Prosthetic valve, (2 MICs)

Answer 6

MIC <= 0.12
-PCN G 12-18 mil QD
-Ceftriaxone 2 g QD
-plus/minus Gent 3 g/kg for 2 wk

MIC > 0.12
-PCN G 12-18 mil QD + Gent 3 mg/kg QD

Question 7

Staph, Native valve

Answer 7

Oxacillin-sus
-Nafcillin or Oxacillin 12g QD
-Allergy: Cefazollin 6g

Oxacillin-res
-Vancomycin
-Alt: Daptomycin

FONDV

Question 8

Staph, Prosthetic valve

Answer 8

Oxacillin-sus
-Naf or Ox 12g + Rifampin 300 mg Q8 + Gentamicin 3 mg (2 wk)

CoNS + PV
-Vanco + Rifampin + Gent

Question 9

Entero, Prosthetic or Native valve

Answer 9

= Ampicillin 2g Q4 + Triaxone 2g Q12 x 6 wk

Resistance or Allergy/UT
= Vanco + Gent

VRE
= Linezolid 600 mg Q12 OR
= Dapto +/- Amp or Taroline

Question 10

HACEK Prosthetic or Native valve

Answer 10

Native
= Ceftriaxone x 4 weeks

Prosthetic
= Ceftriaxone x 6 weeks

Intolerance
= FQ x 6 weeks