EXTRA: Antibiotics for CV Infections Flashcards
What are the 4 major risk factors associated with an increased risk of developing acute rheumatic fever?
- Multiple previous attacks of acute RF
- Short intervals btw attacks of acute RF
- Pt’s w/ increased risk exposure to Strep infections (i.e., children, parents, healthcare and daycare workers, military recruits, and college dorms)
- Young age
What is the emperic treatment for acute rheumatic fever?
Penicillin G + Gentamicin
What is the drug of choice for treating acute RF infection?
Penicillin G
If pt with acute RF has penicillin allergy or hypersensitivity to beta lactams what 4 drugs can you give instead?
- Erythromycin, Azithromycin, Clarithromycin = macrolides
- Clindamycin
If there are concerns for recurrent acute RF in a patient hypersensitive to beta-lactams what are the 3 prophylactic drug options?
Erythromycin, Azithromycin, Clarithromycin = Macrolides
Which AE associated with clindamycin is why you don’t use it for prophylaxis of recurrent acute RF?
Chance of eliciting opportunistic infection of GI tract by C. difficile
What is the empiric treatment for infective endocarditis?
Vancomycin (IV) + Gentamicin (or ceftriaxone)
*MUST give vancomycin via IV for systemic effects
Which pharmacologic agents can be used to provide symptomatic relief/manage the joint pain and fever associated with acute RF?
NSAIDs like aspirin or naproxen
Through which mechanism does Vancomycin act as a cell wall synthesis inhibitor?
Prevents association of D-alanine-D-alanine subunits
If IE is due to S. viridans and is highly penicillin-susceptible which 2 Abx can be used?
- Penicillin G
OR
- Ceftriaxone
If IE is due to S. viridans and you want to treat w/ shorter course of abx in pt with no pre-existing renal disease what are your 2 options?
- Gentamcin + penicillin G
OR
- Gentamicin + ceftriaxone
If IE is due to S. viridans and pt has a mile penicillin (beta-lactam) allergy what are your 2 options for abx?
- Ceftriaxone
Or
- Gentamicin + Ceftriaxone
If IE is due to S. viridans and pt has severe penicillin (beta-lactam) allergy, what is the preferred Abx and what is an alternative?
- Preferred = Penicillin desensitization
- Alternative = Vancomycin
Briefly describe how penicillin densisitization works; how many units must be given before full dose can be administered?
- 1 unit of drug is given via IV and pt is observed for 15-30 mins
- No reaction = dose gradually increased every 15-30 mins (tenfold or doubling)
- Once 2 million units reached, the remainder of dose can be given.
What is the caveat about performing penicillin densensitization on a pt once they leave the hospital or are off tx?
- Drug MUST be physically present to maintain desensitization
- If pt is off drug they will need to be resensitized
If IE is due to S. aureus that is MSSA what 2 abx choices are there?
- Nafcillin
or
- Oxacillin
If IE is due to S. aureus that is MRSA what 2 Abx can given and which is preferred?
- Preferred = Vancomycin
- Alternative = Daptomycin
If IE is due to S. aureus, and pt has a mild penicillin allergy which Abx should be used?
Cefazolin (1st gen. ceph)
If IE is due to S. aureus, and pt has severe penicillin allergy which 2 abx can be used?
- Vancomycin
or
- Daptomycin
Which Abx should be used in causes where there are complications of a brain abscess accompanying IE?
Nafcillin
What is the MOA of Daptomycin?
- Binds to cell membrane via Ca2+-dependent insertion of its lipid tail
- Leads to depolarization, K+ efflux, and rapid cell death
If IE is due to S. epidermidis and other coagulase-neg. staphylococci, which Abx should be used?
Vancomycin
If IE is due to the HACEK group which Abx should be used?
Ceftriaxone
If IE is due to Enterococci (mostyl E. faecalis) what Abx combo should be used?
What if pt has penicillin allergy?
- [Penicillin G or Ampicillin or Vancomycin] + gentamicin
- Use vancomycin if pt has penicillin allergy
What is the empiric treatment of pericarditis in immunocompetent pt’s?
Need to monitor what?
- NSAID (i.e., Aspirin or Naproxen) + colchicine
- Important to order CRP to track treatment (measures inflammation)
What drug is used is severe or refractory cases of pericarditis?
Comes with what risk?
- Corticosteroids (i.e., prednisone)
- Risk to prolong illness or increase chance of relapse
What is the MOA of Colchicine which makes it anti-inflammatory?
- Binds tubulin and prevents tubulin polymerization –> microtubules
- Leads to inhibition of leukocyte migration and phagocytosis
What are the AE’s associated with Colchicine and more likely via which route of administration?
- Diarrhea and ocassionaly N/V and abdominal pain
- Hair loss, bone marrow depression, periperal neuritis or myopathy
- MORE likely seen with IV vs. oral administration
