Endocarditis Flashcards
What is endocarditis?
A bacterial infection which causes inflammation of the endocardium - membrane of the heart chambers and surface of valves.
What are some common symptoms of endocarditis?
Red painless spots which look like blood blisters.
Red painful lumps on fingers and toes
Chest pain when breathing
Fever
Chills
SOB
A murmur
How is suspected native valve endocarditis treated?
Amoxicillin or Ampicillin + low-dose gentamicin if necessary
How is suspected prosthetic valve endocarditis treated?
Vancomycin + rifampicin + low-dose gentamicin
How is native valve endocarditis caused by staphylococci treated?
Flucloxacillin for 4 weeks
Penicillin allergy or MRSA: vancomycin + rifampicin for 4-6 weeks.
How is prosthetic valve endocarditis caused by staphylococci treated?
Flucloxacillin + rifampicin + low-dose gentamicin for 6+ weeks.
Penicillin allergy or MRSA - vancomycin + rifampicin + low-dose gentamicin
How is endocarditis caused by fully-sensitive streptococci treated?
Benzylpenicilliin 4-6 weeks (6 if prosthetic)
Penicillin allergy: vancomycin (or teicoplanin) + low-dose gentamicin for 4-6 weeks (stop gentamicin after 2)
How is endocarditis caused by less-sensitive streptococci treated?
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)
What class of antibiotic is Rifampicin
Rifamycin
How does rifampicin work?
Inhibits bacterial DNA-dependent RNA polymerase by binding in the polymerase subunit deep within the DNA/RNA channel to prevent elongation of RNA.
What side effects does rifampicin cause?
GI discomfort
Thrombocytopenia
Leucopenia
Pyschosis
In what conditions is rifampicin contraindicated?
Acute porphyria
Jaundice
Which key drug interactions apply to rifampicin?
Hormonal contraceptive efficacy reduced.
What monitoring does rifampicin require?
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.
What antibiotic class is teicoplanin?
Glycopeptide
What side effects can teicoplanin cause?
Blood disorders
Ototoxicity
Pain
Skin reactions
Fever
BOPS F
What drugs can teicoplanin interact with?
Nephrotoxic drugs
What monitoring does teicoplanin require
Blood counts
Hepatic function
Renal function
In renal impairment, monitor auditory function.
How does teicoplanin differ to vancomycin?
Has a longer duration so can be given once daily.
Why should teicoplanin not be used for systemic infections?
Low absorption.
What is gentamicins usual dosing regimen?
Once daily, 5mg/kg up to max 500mg
When is gentamicin’s once daily dosing regimen not used?
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)
What antibiotic class is gentamicin?
Aminoglycoside
What monitoring does gentamicin require?
If injected, requires TDM.
How should gentamicin TDM appeat for once daily dose regimen?
1-hour (peak) serum concentration should be 5-10mg/L.
Pre-dose (trough) serum concentratoin should be <2mg/L.
How should gentamicin TDM appear for multiple daily dose regimen?
1-hour (peak) serum concentration should be 3-5mg/L.
Pre-dose (trough) serum concentratoin should be <1mg/L.
How often should gentamicin TDM be done?
After 3 or 3 doses, then at least every 3 days and after a dose change.
