TAILIEUCHUNG - Chapter 118. Infective Endocarditis (Part 9)

Other Organisms In the absence of meningitis, endocarditis caused by Streptococcus pneumoniae with a penicillin MIC of ≤ can be treated with IV penicillin (4 million units every 4 h), ceftriaxone (2 g/d as a single dose), or cefotaxime (at a comparable dosage). Infection caused by pneumococcal strains with a penicillin MIC of ≥ should be treated with vancomycin. Until the strain's susceptibility to penicillin is established, therapy should consist of vancomycin plus ceftriaxone, especially if concurrent meningitis is suspected. P. aeruginosa endocarditis is treated with an antipseudomonal penicillin (ticarcillin or piperacillin) and high doses of tobramycin (8 mg/kg. | Chapter 118. Infective Endocarditis Part 9 Other Organisms In the absence of meningitis endocarditis caused by Streptococcus pneumoniae with a penicillin MIC of can be treated with IV penicillin 4 million units every 4 h ceftriaxone 2 g d as a single dose or cefotaxime at a comparable dosage . Infection caused by pneumococcal strains with a penicillin MIC of should be treated with vancomycin. Until the strain s susceptibility to penicillin is established therapy should consist of vancomycin plus ceftriaxone especially if concurrent meningitis is suspected. P. aeruginosa endocarditis is treated with an antipseudomonal penicillin ticarcillin or piperacillin and high doses of tobramycin 8 mg kg per day in three divided doses . Endocarditis caused by Enterobacteriaceae is treated with a potent 0-lactam antibiotic plus an aminoglycoside. Corynebacterial endocarditis is treated with penicillin plus an aminoglycoside if the organism is susceptible to the aminoglycoside or with vancomycin which is highly bactericidal for most strains. Therapy for Candida endocarditis consists of amphotericin B plus flucytosine and early surgery longterm if not indefinite suppression with an oral azole is advised. Caspofungin treatment of Candida endocarditis has been effective in sporadic cases nevertheless the role of echinocandins in this setting has not been established. Empirical Therapy In designing and executing therapy without culture data . before culture results are known or when cultures are negative clinical and epidemiologic clues to etiology must be weighed and both the pathogens associated with the specific endocarditis syndrome and the hazards of suboptimal therapy must be considered. Thus empirical therapy for acute endocarditis in an injection drug user should cover MRSA and gram-negative bacilli. The initiation of treatment with vancomycin plus gentamicin immediately after blood is obtained for cultures covers these as well as many other potential causes. In .

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