Endocarditis

Question 1

What is endocarditis?

Answer 1

A bacterial infection which causes inflammation of the endocardium - membrane of the heart chambers and surface of valves.

Question 2

What are some common symptoms of endocarditis?

Answer 2

Red painless spots which look like blood blisters.
Red painful lumps on fingers and toes
Chest pain when breathing
Fever
Chills
SOB
A murmur

Question 3

How is suspected native valve endocarditis treated?

Answer 3

Amoxicillin or Ampicillin + low-dose gentamicin if necessary

Question 4

How is suspected prosthetic valve endocarditis treated?

Answer 4

Vancomycin + rifampicin + low-dose gentamicin

Question 5

How is native valve endocarditis caused by staphylococci treated?

Answer 5

Flucloxacillin for 4 weeks

Penicillin allergy or MRSA: vancomycin + rifampicin for 4-6 weeks.

Question 6

How is prosthetic valve endocarditis caused by staphylococci treated?

Answer 6

Flucloxacillin + rifampicin + low-dose gentamicin for 6+ weeks.

Penicillin allergy or MRSA - vancomycin + rifampicin + low-dose gentamicin

Question 7

How is endocarditis caused by fully-sensitive streptococci treated?

Answer 7

Benzylpenicilliin 4-6 weeks (6 if prosthetic)

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

Question 8

How is endocarditis caused by less-sensitive streptococci treated?

Answer 8

Benzylpenicilliin + low-dose gentamicin for 4-6 weeks (6 if prosthetic) (review gentamicin at 2 weeks)

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

Question 9

What class of antibiotic is Rifampicin

Answer 9

Rifamycin

Question 10

How does rifampicin work?

Answer 10

Inhibits bacterial DNA-dependent RNA polymerase by binding in the polymerase subunit deep within the DNA/RNA channel to prevent elongation of RNA.

Question 11

What side effects does rifampicin cause?

Answer 11

GI discomfort
Thrombocytopenia
Leucopenia
Pyschosis

Question 12

In what conditions is rifampicin contraindicated?

Answer 12

Acute porphyria
Jaundice

Question 13

Which key drug interactions apply to rifampicin?

Answer 13

Hormonal contraceptive efficacy reduced.

Question 14

What monitoring does rifampicin require?

Answer 14

Hepatic function - baseline.
In hepatic impairment, or alcohol dependence monitor LFTs weekly for every 2 weeks, then every 2 weeks for 6 weels.

Hepatic function -baseline.

Question 15

What antibiotic class is teicoplanin?

Answer 15

Glycopeptide

Question 16

What side effects can teicoplanin cause?

Answer 16

Blood disorders
Ototoxicity
Pain
Skin reactions
Fever

BOPS F

Question 17

What drugs can teicoplanin interact with?

Answer 17

Nephrotoxic drugs

Question 18

What monitoring does teicoplanin require

Answer 18

Blood counts

Hepatic function

Renal function
In renal impairment, monitor auditory function.

Question 19

How does teicoplanin differ to vancomycin?

Answer 19

Has a longer duration so can be given once daily.

Question 20

Why should teicoplanin not be used for systemic infections?

Answer 20

Low absorption.

Question 21

What is gentamicins usual dosing regimen?

Answer 21

Once daily, 5mg/kg up to max 500mg

Question 22

When is gentamicin’s once daily dosing regimen not used?

Answer 22

When it is used synergistically with another antibiotic.

In pregnancy

When the patient has abnormal volume of distribution

If treating a major burn (>20% SA)

Question 23

What antibiotic class is gentamicin?

Answer 23

Aminoglycoside

Question 24

What monitoring does gentamicin require?

Answer 24

If injected, requires TDM.

Question 25

How should gentamicin TDM appeat for once daily dose regimen?

Answer 25

1-hour (peak) serum concentration should be 5-10mg/L.
Pre-dose (trough) serum concentratoin should be <2mg/L.

Question 26

How should gentamicin TDM appear for multiple daily dose regimen?

Answer 26

1-hour (peak) serum concentration should be 3-5mg/L.
Pre-dose (trough) serum concentratoin should be <1mg/L.

Question 27

How often should gentamicin TDM be done?

Answer 27

After 3 or 3 doses, then at least every 3 days and after a dose change.