Endocarditis

Question 1

Most common pathogen for endocarditis

Answer 1

Streptococcus (50%) > S. aureus

Question 2

Endocarditis treatment duration with prosthetic valve

Answer 2

Always at least 6 weeks

Question 3

Endocarditis treatment duration for native valve

Answer 3

4-6 weeks

May be as short as 2 weeks in oral streptococci endocarditis

Question 4

Recommended therapy for PCN-susceptible oral streptococci & S. gallolyticus endocarditis

Answer 4

PCN G

PCN G + gentamicin 3mg/kg/day (2 wks)

Amoxicillin (2 wks)

Ceftriaxone

Ceftriaxone + gentamicin (2 wks)

Vancomycin if unable to tolerate PCN/ceftriaxone

Question 5

Recommended therapy PCN-resistant oral streptococci & S. gallolyticus endocarditis

Answer 5

PCN G + gentamicin (if native valve, gent for 2 weeks only, if prosthetic, both for 6 weeks)

Amoxicillin + gentamicin

Ceftriaxone + gentamicin

Vancomycin if unable to tolerate PCN, ceftriaxone

Question 6

MSSA endocarditis recommended therapy

Answer 6

Oxacillin, nafcillin, or cefazolin.
If prosthetic valve, add rifampin and gentamicin (gent for 2 weeks only)

Daptomycin if severe PCN allergy (+ gent, rifampin if prosthetic)

Must be 6 weeks for either native/prosthetic

Question 7

MRSA endocarditis recommended therapy

Answer 7

Vancomycin
If prosthetic valve, add rifampin and gentamicin (gent for first 2 weeks only)

Daptomycin +/- ceftaroline (native valve only)

Question 8

Enterococcus endocarditis recommended therapy

Answer 8

Ampicillin + gentamicin

Ampicillin + ceftriaxone

Vancomycin + gentamicin (if unable to tolerate B lactam)

6 weeks

Question 9

B lactam resistant Entercoccus endocarditis recommended therapy

Answer 9

Vancomycin + gentamicin

6 weeks

Question 10

PCN, aminoglycoside, vanco resistant Enterococcus endocarditis recommended therapy

Answer 10

Daptomycin + ampicillin, ertapenem, or ceftaroline

> 6 weeks duration

Question 11

HACEK endocarditis recommended therapy

Answer 11

Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella

Ceftriaxone

Ampicillin + gentamicin

FQ

Question 12

Endocarditis prophylaxis in these populations

Answer 12

-Prosthetic cardiac valve
-History of bacterial endocarditis
-Congenital heart disease
-Cardiac transplant recipients with cardiac valvulopathy (LVADs, heart transplant)

Question 13

Procedures requiring endocarditis prophylaxis

Answer 13

Dental procedures that perforate oral mucosa

Respiratory, GI/GU, skin, musculoskeletal diagnostic or therapeutic procedures

Question 14

Standard endocarditis prophylaxis regimen

Answer 14

1 hour before procedure:
Amoxicillin 2gm
Amoxicillin 50mg/kg (children)

Question 15

Endocarditis prophylaxis regimen if penicillin allergy

Answer 15

1 hour before procedure:
-Cephalexin 2gm (or 50mg/kg)
-Azith/clarith 500mg (15 mg/kg)
-Doxycycline 100mg (2.2 mg/kg <45kg)
-Cefazolin/ceftriaxone 1gm IM/IV (50mg/kg IV/IM)

Question 16

Endocarditis prophylaxis if unable to take PO

Answer 16

30 minutes before procedure:
Ampicillin 2gm IM/IV (50mg/kg)
Cefazolin/ceftriaxone 1gm IM/IV (50mg/kg)