endocarditis therapeutics Flashcards
pathophysiology of endocarditis
- previously damaged heart valve
- platelet-fibrin deposition creating thrombosis
- bacteremia
- bacterial adherence to thrombus
procedures associated with bacteremia
- dental extraction
- tonsillectomy
- cystoscopy
- tooth brushing/flossing
most common bacteria in endocarditis
staph
strep
clinical presentations of endocarditis
- fever
- cough
- dyspnea
- anorexia
- weight loss
- night sweats
- fatigue
- splenomegaly
- back pain
less common presentations of endocarditis
- clubbing fingertips
- splinter hemorrhages
- retinal eye lesions
uncommon presentations of endocarditis
- osler’s nodes (painful)
- janeway lesions (nontender)
symptoms of right heart failure
- nausea, abdominal pain
- peripheral edema
- hepatojugular reflux
- JVD
- hepatomegaly
- anorexia
- constipation
symptoms of left heart failure
- dyspnea
- nocturnal dyspnea
- othopnea
- tachypnea
- hemoptysis
- pulmonary edema
- S3 gallop
endocardiditis workup plan
- identify Sx including CHF
- 3 consecutive blood cultures for >90% (draw 1st & 3rd at least 1 hours apart)
- venopuncture 1 culture = 2 bottles (aerobe and anaerobe)
- echocardiogram
- chest x-ray
antibiotics for native valve S.viridans
PCN
ceftriazone
vancomycin
antibiotics for enterococcus in endocarditis
-linezolid
-daptomycin
for over 6 weeks
antibiotics for native valve MSSA
nafcillin
cefazolin
antibiotics for native valve MRSA
vancomycin
daptomycin
empiric antibiotics for prosthetic valve when IE develops <2 months after placed
vanco +
- gent
- rifampin
empiric antibiotics for prosthetic valve when IE develops >2 after placed
vanco +
- gent
- rifampin
antibiotics for prosthetic valve w/ PCN susceptible if MIC < 0.12 viridans strep and S.gallolyticus
-PCN g x6wk
-ceftriaxone x6wk
-ampicillin x6wk
+/- gentamycin x2wk
-vancomycin x6wk
antibiotics for prosthetic valve w/ PCN resistance or MIC >0.12 in viridans strep and S.gallolyticus
- PCN G +gent
- ceftriaxone +gent
- vancomycin
antibiotics for prosthetic valve MSSA infection
nafcillin +
- rifampin TID
- gentamicin
antibiotics for prosthetic valve MRSA infection
- vanco+rifampin+gent
- vanco
- rifampin
- gent
HACEK IE features
- slow growers over 2-3 weeks (cultures needs lots of time)
- large friable vegetaitons
antibiotics for HACEK in native or prosthetic valves
ceftriaxone first
- native = 4 weeks
- prosthetic = 6 weeks
- other options after C&S amp/sulbac or cipro
complication of IE
CHF
prophylaxis of IE is recommended for
-patients with prior outlined condition
AND
-who undergo procedures likely to enhance bacteremia
conditions that prophylaxis are recommended for
- prosthetic valves or valve repair
- prior IE
- congenital heart disease
- heart transplant w/ regurgitation
procedures that prophylaxis is recommended for
- dental procedures involving gingival tissue
- periapical region of teeth
- perforation of oral mucosa
antibiotics for dental prophylaxis
- amoxicillin 2g
- ampicillin 2g
- clindamycin 600 mg
- azithromycin 500 mg
- clarithromycin 500 mg
- cephalexin 2g
- clindamycin 600 mg
- cefazolin 1g
