Infective endocarditis: Difference between revisions

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(→: rearranged table and added enterococci)
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* Varies by causative organism and prosthetic vs. native valve
  
* Varies by causative organism and prosthetic vs. native valve
   
−
{| class="wikitable sortable"
 +
{| class="wikitable"
−
! Organism
  
 
! Indication
  
! Indication
 
! Antibiotic
  
! Antibiotic
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! Notes
  
! Notes
 
|-
  
|-
−
| MSSA and other oxacillin-susceptible [[Staphylococcus]]
 +
! colspan=5 | MSSA and other oxacillin-susceptible ''[[Staphylococcus]]''
  +
|-
 
| NVE
  
| NVE
−
| [[oxacillin]] || 12 g/day IV in 4-6 divided doses || 6 weeks
 +
| [[oxacillin]] || 12 g/day IV in 4-6 doses || 6 weeks
 
| can treat for 2 weeks in uncomplicated right-sided NVE
  
| can treat for 2 weeks in uncomplicated right-sided NVE
 
|-
  
|-
⚫
| MSSA and other oxacillin-susceptible [[Staphylococcus]]
  
 
| NVE
  
| NVE
−
| [[cefazolin]] || 6 g/day IV in 3 divided doses || 6 weeks
 +
| [[cefazolin]] || 6 g/day IV in 3 doses || 6 weeks
 
| in patients with non-anaphylactoid penicillin allergy
  
| in patients with non-anaphylactoid penicillin allergy
 
|-
  
|-
  +
| rowspan=3 | PVE
−
| MRSA and other oxacillin-resistant [[Staphylococcus]]
  
  +
| [[oxacillin]], plus
  +
| 12 g/day in 6 doses
  +
| rowspan=2 | ≥6 weeks
  ⚫
| rowspan=3 | use cefazolin or vancomycin if allergy
  +
|-
  +
| [[rifampin]], plus
  +
| 900 mg/day IV/PO in 3 doses
  +
|-
  +
| [[gentamicin]]
  +
| 3 mg/kg/day IV/IM in 2-3 doses
  +
| 2 weeks
  +
|-
  ⚫
! colspan=5 | MRSA and other oxacillin-resistant ''[[Staphylococcus]]''
  +
|-
 
| NVE
  
| NVE
−
| [[vancomycin]] || 30 mg/kg/day IV in 2 divided doses || 6 weeks
 +
| [[vancomycin]] || 30 mg/kg/day IV in 2 doses || 6 weeks
 
| target trough 10-20 μg/mL
  
| target trough 10-20 μg/mL
 
|-
  
|-
−
| MRSA and other oxacillin-resistant [[Staphylococcus]]
  
 
| NVE
  
| NVE
 
| [[daptomycin]] || ≥8 mg/kg/dose || 6 weeks
  
| [[daptomycin]] || ≥8 mg/kg/dose || 6 weeks
 
|
  
|
 
|-
  
|-
  +
| rowspan=3 | PVE
−
| MSSA and other oxacillin-susceptible [[Staphylococcus]]
  
  +
| [[vancomycin]], plus
⚫
| PVE
  
  +
| 30 mg/kg/day in 2 doses
−
| [[oxacillin]], plus<br/>[[rifampin]], plus<br/>[[gentamicin]]
  
  +
| rowspan=2 | ≥6 weeks
−
| 12 g/day in 6 divided doses<br/>900 mg/day IV or PO in 3 divided doses<br/>3 mg/kg/day IV or IM in 2-3 divided doses
  
  ⚫
| rowspan=3 | target vancomycin trough of 10-20 μg/mL
−
| ≥6 weeks<br/>≥6 weeks<br/>2 weeks
  
⚫
| use cefazolin or vancomycin if allergy
  
 
|-
  
|-
  +
| [[rifampin]], plus
−
| MRSA and other oxacillin-resistant [[Staphylococcus]]
  
  +
| 900 mg/day IV/PO in 3 doses
⚫
| PVE
  
  +
|-
−
| [[vancomycin]], plus<br/>[[rifampin]], plus<br/>[[gentamicin]]
  
  +
| [[gentamicin]]
−
| 30 mg/kg/day in 2 divided doses<br/>900 mg/day IV or PO in 3 divided doses<br/>3 mg/kg/day IV or IM in 2-3 divided doses
  
  +
| 3 mg/kg/day IV/IM in 2-3 doses
−
| ≥6 weeks<br/>≥6 weeks<br/>2 weeks
  
  +
| 2 weeks
⚫
| target trough of 10-20 μg/mL
  
  +
|-
  +
! colspan=5 | ''[[Enterococcus]]'' susceptible to [[penicillin]] and [[gentamicin]]
  +
|-
  +
| rowspan=2 | NVE or PVE
  +
| [[ampicillin]], plus
  +
| 2 g IV q4h
  +
| rowspan=2 | 4-6 weeks
  +
| rowspan=2 | 4 weeks if symptoms <3 months; 6 weeks if symptoms >3 months or if PVE
  +
|-
  +
| [[gentamicin]]
  +
| 3 mg/kg IBW in 2-3 doses
  +
|-
  +
| rowspan=2 | NVE or PVE
  +
| [[ampicillin]], plus
  +
| 2 g IV q4h
  +
| rowspan=2 | 6 weeks
  +
| rowspan=2 | alternative regimen if CrCl <50
  +
|-
  +
| [[ceftriaxone]]
  +
| 2 g IV q12h
  +
|-
  +
! colspan=5 | ''[[Enterococcus]]'' susceptible to [[penicillin]] and resistant to [[aminoglycosides]]
  +
|-
  +
| rowspan=2 | NVE or PVE
  +
| [[ampicillin]], plus
  +
| 2 g IV q4h
  +
| rowspan=2 | 6 weeks
  +
| rowspan=2 |
  +
|-
  +
| [[ceftriaxone]]
  +
| 2 g IV q12h
  +
|-
  +
! colspan=5 | ''[[Enterococcus]]'' resistant to [[penicillin]] and susceptible to [[vancomycin]] and [[aminoglycosides]]
  +
|-
  +
| rowspan=2 | NVE or PVE
  +
| [[vancomycin]], plus
  +
| 30 mg/kg/day IV in 2 doses
  +
| rowspan=2 | 6 weeks
  +
| rowspan=2 |
  +
|-
  +
| [[gentamicin]]
  +
| 3 mg/kg/day IV/IM in 3 doses
  +
|-
  +
! colspan=5 | ''[[Enterococcus]]'' resistant to [[penicillin]], [[aminoglycosides]], and [[vancomycin]]
  +
|-
  ⚫
| NVE or PVE
  +
| [[linezolid]]
  +
| 600 mg IV/PO q12h
  +
| &gt;6 weeks
  +
|
  +
|-
  ⚫
| NVE or PVE
  +
| [[daptomycin]]
  +
| 10-12 mg/kg/dose
  +
| &gt;6 weeks
  +
|
 
|}
  
|}
   

Revision as of 21:39, 9 March 2020

Background

  • Infection of heart valves, either prosthetic or native

Organisms

Clinical Presentation

Management

  • Varies by causative organism and prosthetic vs. native valve
Indication Antibiotic Dose Duration Notes
MSSA and other oxacillin-susceptible Staphylococcus
NVE oxacillin 12 g/day IV in 4-6 doses 6 weeks can treat for 2 weeks in uncomplicated right-sided NVE
NVE cefazolin 6 g/day IV in 3 doses 6 weeks in patients with non-anaphylactoid penicillin allergy
PVE oxacillin, plus 12 g/day in 6 doses ≥6 weeks use cefazolin or vancomycin if allergy
rifampin, plus 900 mg/day IV/PO in 3 doses
gentamicin 3 mg/kg/day IV/IM in 2-3 doses 2 weeks
MRSA and other oxacillin-resistant Staphylococcus
NVE vancomycin 30 mg/kg/day IV in 2 doses 6 weeks target trough 10-20 μg/mL
NVE daptomycin ≥8 mg/kg/dose 6 weeks
PVE vancomycin, plus 30 mg/kg/day in 2 doses ≥6 weeks target vancomycin trough of 10-20 μg/mL
rifampin, plus 900 mg/day IV/PO in 3 doses
gentamicin 3 mg/kg/day IV/IM in 2-3 doses 2 weeks
Enterococcus susceptible to penicillin and gentamicin
NVE or PVE ampicillin, plus 2 g IV q4h 4-6 weeks 4 weeks if symptoms <3 months; 6 weeks if symptoms >3 months or if PVE
gentamicin 3 mg/kg IBW in 2-3 doses
NVE or PVE ampicillin, plus 2 g IV q4h 6 weeks alternative regimen if CrCl <50
ceftriaxone 2 g IV q12h
Enterococcus susceptible to penicillin and resistant to aminoglycosides
NVE or PVE ampicillin, plus 2 g IV q4h 6 weeks
ceftriaxone 2 g IV q12h
Enterococcus resistant to penicillin and susceptible to vancomycin and aminoglycosides
NVE or PVE vancomycin, plus 30 mg/kg/day IV in 2 doses 6 weeks
gentamicin 3 mg/kg/day IV/IM in 3 doses
Enterococcus resistant to penicillin, aminoglycosides, and vancomycin
NVE or PVE linezolid 600 mg IV/PO q12h >6 weeks
NVE or PVE daptomycin 10-12 mg/kg/dose >6 weeks

References

  1. ^  Kasper Iversen, Nikolaj Ihlemann, Sabine U. Gill, Trine Madsen, Hanne Elming, Kaare T. Jensen, Niels E. Bruun, Dan E. Høfsten, Kurt Fursted, Jens J. Christensen, Martin Schultz, Christine F. Klein, Emil L. Fosbøll, Flemming Rosenvinge, Henrik C. Schønheyder, Lars Køber, Christian Torp-Pedersen, Jannik Helweg-Larsen, Niels Tønder, Claus Moser, Henning Bundgaard. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. New England Journal of Medicine. 2019;380(5):415-424. doi:10.1056/nejmoa1808312.
  2. ^  John A Wildenthal, Andrew Atkinson, Sophia Lewis, Sena Sayood, Nathanial S Nolan, Nicolo L Cabrera, Jonas Marschall, Michael J Durkin, Laura R Marks. Outcomes of Partial Oral Antibiotic Treatment for Complicated Staphylococcus aureus Bacteremia in People Who Inject Drugs. Clinical Infectious Diseases. 2022;76(3):487-496. doi:10.1093/cid/ciac714.
  3. ^  Sarah Freling, Noah Wald-Dickler, Josh Banerjee, Catherine P Canamar, Soodtida Tangpraphaphorn, Dara Bruce, Kusha Davar, Fernando Dominguez, Daniel Norwitz, Ganesh Krishnamurthi, Lilian Fung, Ashley Guanzon, Emi Minejima, Michael Spellberg, Catherine Spellberg, Rachel Baden, Paul Holtom, Brad Spellberg. Real-World Application of Oral Therapy for Infective Endocarditis: A Multicenter, Retrospective, Cohort Study. Clinical Infectious Diseases. 2023;77(5):672-679. doi:10.1093/cid/ciad119.

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