IE management Flashcards
what are the 4 goals of IE therapy?
1- prompt diagnosis
2- determine if you need prosthetic pieces or nah
3- determine if you need to do surgery or nah
4- prevention and follow up
what is main component and characteristic of empirical therapy?
should cover all possible infections, strept, staph, entercocci
usually its vancomycin
staph IE happens in which group of people?
drug abusers
do we always give prophylaxis?
no cuz it doesnt make a difference and it might cause adverse effects
in which cases we give prophylaxis?
1- patients with prosthetic heart pieces
2- patients with previous IE
3-patients with congenital cyanosis
at what type of operations you need
surgeries that disturb the oral mucosa and gingival peripheral region
surgeries done in infected fields
how do you administer medications in empirical therapy and treatment?
IV only
how do you administer medications in prophylaxis ?
IV, IM, Orally
whats the prophylaxis regiment for non allergic people
Amoxcillin orally
Ampicillin iv/im
Ceftriaxone/Cefazolin IV/IM
what is the prophylaxis regiment for allergic people
cephalexin = orally
azithromycin/clarithromycin = orally –> macrolids
Deoxyclycin = orally –> tetracyclin
ceftriaxone/cefazolin —> IV/IM
what are the 3 main characteristics of treatment?
Bacterocidal
Prolonged
Parentally
What is late prosthetic valves and early prosthetic valves?
Late prosthetic valves are older than one year and they are treated like native vavles
Early prosthetic valves are «_space;1 year
what is the regiment for community acquired IE of Native valve or Late prosthetic valves empiric therapy
- Amplicillin IV
- Ceftrioxone IV OR flucolaxillin IF ITS STAPH IV
-Gentamicin IV
What is the regiment for Hospital acquired IE + early prosthetic valves empiric therapy
- Vancomycin / daptomycin IV
- Rifapmin iv
- Gentamicin IV
what is the regiment for allergic people? empiric therapy
-Vancomycin / daptomycin IV
- Cefazolin IV
- Gentamicin IV
what drug you add for prosthetic valves?
Rifapmin
what are the adverse effects of gentamicin? and how long you can give it for
nephrotoxicity and ototoxicity
2 weeks
what is the advantage of using Aminoglycosides and Cell wall inhibitors?
cell wall inhibitors make the walls more permeable and allows aminoglycosides in
what is the best combination to treat IE due to E. faecalis
ampicillin and ceftriaxone
whats the difference in treatment between Native valve Endo and Prosthetic valve Endo
The native valve treatment lasts for 4 weeks
Prosthetic valve lasts for 6 weeks and if its early prosthetic valve add rifapmin
What is the treatment regimens for strept IE?
- Penicillin G
- Amoxcillin
- Ceftriaxone
FOR 4 weeks for Native Valve TO 6 WEEKS FOR PROSTHETIC VALVES
if you want to finish in 2 weeks, ADD GENTAMICIN
IF PENICLLIN ALLERGY give Vancomycin/daptomycin
Add rifapmin if early prosthetic valve
whats the regiment for relatively resistance STREPT IE?
same as normal js increase the dose and ADD GENTAMICIN for 2 weeks.
whats the treatment regiment for STAPH IE?
- Flucloxacillin cuz its staph IV
- Cefazoline IV
IF early prosthetic valve ADD RIFAPMIN AND GENTAMICIN
what drug you give for MRSA?
vancomycin
