Infective endocarditis: Difference between revisions

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|-
 
|-
 
| rowspan=3 | PVE
 
| rowspan=3 | PVE
| [[oxacillin]], plus
+
| [[oxacillin]]
 
| 2 g IV q4h
 
| 2 g IV q4h
 
| rowspan=2 | ≥6 weeks
 
| rowspan=2 | ≥6 weeks
 
| rowspan=3 | use cefazolin or vancomycin if allergy
 
| rowspan=3 | use cefazolin or vancomycin if allergy
 
|-
 
|-
| [[rifampin]], plus
+
| + [[rifampin]]
 
| 300 mg IV/PO q8h
 
| 300 mg IV/PO q8h
 
|-
 
|-
| [[gentamicin]]
+
| + [[gentamicin]]
 
| 1 mg/kg IV/IM q8h
 
| 1 mg/kg IV/IM q8h
 
| 2 weeks
 
| 2 weeks
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|-
 
|-
 
| rowspan=3 | PVE
 
| rowspan=3 | PVE
| [[vancomycin]], plus
+
| [[vancomycin]]
 
| 15 mg/kg IV q12h
 
| 15 mg/kg IV q12h
 
| rowspan=2 | ≥6 weeks
 
| rowspan=2 | ≥6 weeks
 
| rowspan=3 | target vancomycin trough of 10-20 μg/mL
 
| rowspan=3 | target vancomycin trough of 10-20 μg/mL
 
|-
 
|-
| [[rifampin]], plus
+
| + [[rifampin]]
 
| 300 mg IV/PO q8h
 
| 300 mg IV/PO q8h
 
|-
 
|-
| [[gentamicin]]
+
| + [[gentamicin]]
 
| 1 mg/kg IV/IM q8h
 
| 1 mg/kg IV/IM q8h
 
| 2 weeks
 
| 2 weeks
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|-
 
|-
 
| rowspan=2 | NVE or PVE
 
| rowspan=2 | NVE or PVE
| [[ampicillin]], plus
+
| [[ampicillin]]
 
| 2 g IV q4h
 
| 2 g IV q4h
 
| rowspan=2 | 4-6 weeks
 
| rowspan=2 | 4-6 weeks
 
| rowspan=2 | 4 weeks if symptoms <3 months; 6 weeks if symptoms >3 months or if PVE
 
| rowspan=2 | 4 weeks if symptoms <3 months; 6 weeks if symptoms >3 months or if PVE
 
|-
 
|-
| [[gentamicin]]
+
| + [[gentamicin]]
 
| 1 mg/kg IV q8h
 
| 1 mg/kg IV q8h
 
|-
 
|-
 
| rowspan=2 | NVE or PVE
 
| rowspan=2 | NVE or PVE
| [[ampicillin]], plus
+
| [[ampicillin]]
 
| 2 g IV q4h
 
| 2 g IV q4h
 
| rowspan=2 | 6 weeks
 
| rowspan=2 | 6 weeks
 
| rowspan=2 | alternative regimen if CrCl <50
 
| rowspan=2 | alternative regimen if CrCl <50
 
|-
 
|-
| [[ceftriaxone]]
+
| + [[ceftriaxone]]
 
| 2 g IV q12h
 
| 2 g IV q12h
 
|-
 
|-
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|-
 
|-
 
| rowspan=2 | NVE or PVE
 
| rowspan=2 | NVE or PVE
| [[ampicillin]], plus
+
| [[ampicillin]]
 
| 2 g IV q4h
 
| 2 g IV q4h
 
| rowspan=2 | 6 weeks
 
| rowspan=2 | 6 weeks
 
| rowspan=2 |
 
| rowspan=2 |
 
|-
 
|-
| [[ceftriaxone]]
+
| + [[ceftriaxone]]
 
| 2 g IV q12h
 
| 2 g IV q12h
 
|-
 
|-
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|-
 
|-
 
| rowspan=2 | NVE or PVE
 
| rowspan=2 | NVE or PVE
| [[vancomycin]], plus
+
| [[vancomycin]]
 
| 15 mg/kg IV q12h
 
| 15 mg/kg IV q12h
 
| rowspan=2 | 6 weeks
 
| rowspan=2 | 6 weeks
 
| rowspan=2 |
 
| rowspan=2 |
 
|-
 
|-
| [[gentamicin]]
+
| + [[gentamicin]]
 
| 1 mg/kg IV/IM q8h
 
| 1 mg/kg IV/IM q8h
 
|-
 
|-
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|-
 
|-
 
| rowspan=2 | NVE
 
| rowspan=2 | NVE
| [[penicillin]] or [[ceftriaxone]], plus
+
| [[penicillin]] or [[ceftriaxone]]
 
| as above
 
| as above
 
| rowspan=2 | 2 weeks
 
| rowspan=2 | 2 weeks
 
| rowspan=2 |
 
| rowspan=2 |
 
|-
 
|-
| [[gentamicin]]
+
| + [[gentamicin]]
 
| 3 mg/kg IV/IM q24h
 
| 3 mg/kg IV/IM q24h
 
|-
 
|-
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| use if allergy, target 10-15 μg/mL
 
| use if allergy, target 10-15 μg/mL
 
|-
 
|-
| rowspan=3 | PVE
+
| rowspan=2 | PVE
| crystalline [[penicillin]] G, or
+
| crystalline [[penicillin]] G
 
| 6 MU IV q4h
 
| 6 MU IV q4h
| rowspan=2 | 6 weeks
+
| 6 weeks
| rowspan=3 |
+
| rowspan=2 |
 
|-
 
|-
  +
| ± [[gentamicin]]
| [[ceftriaxone]], with or without
 
  +
| 3 mg/kg IV/IM q24h
  +
| 2 weeks
  +
|-
  +
| rowspan=2 | PVE
 
| [[ceftriaxone]]
 
| 2 g IV/IM q24h
 
| 2 g IV/IM q24h
  +
| 6 weeks
  +
| rowspan=2 |
 
|-
 
|-
| [[gentamicin]]
+
| ± [[gentamicin]]
 
| 3 mg/kg IV/IM q24h
 
| 3 mg/kg IV/IM q24h
 
| 2 weeks
 
| 2 weeks
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|-
 
|-
 
| rowspan=2 | NVE
 
| rowspan=2 | NVE
| crystalline [[penicillin]] G, plus
+
| crystalline [[penicillin]] G
 
| 6 MU IV q4h
 
| 6 MU IV q4h
 
| 4 weeks
 
| 4 weeks
 
| rowspan=2 |
 
| rowspan=2 |
 
|-
 
|-
| [[gentamicin]]
+
| + [[gentamicin]]
 
| 3 mg/kg IV/IM q24h
 
| 3 mg/kg IV/IM q24h
 
|-
 
|-
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| use if allergy, target 10-15 μ/mL
 
| use if allergy, target 10-15 μ/mL
 
|-
 
|-
| rowspan=3 | PVE
+
| rowspan=2 | PVE
| crystalline [[penicillin]] G, or
+
| crystalline [[penicillin]] G
 
| 6 MU IV q4h
 
| 6 MU IV q4h
| rowspan=3 | 6 weeks
+
| rowspan=2 | 6 weeks
| rowspan=3 |
+
| rowspan=2 |
 
|-
 
|-
| [[ceftriaxone]], plus
+
| + [[gentamicin]]
  +
| 3 mg/kg IV/IM q24h
  +
|-
  +
| rowspan=2 | PVE
  +
| [[ceftriaxone]]
 
| 2 g IV/IM q24h
 
| 2 g IV/IM q24h
  +
| rowspan=2 | 6 weeks
  +
| rowspan=2 |
 
|-
 
|-
| [[gentamicin]]
+
| + [[gentamicin]]
 
| 3 mg/kg IV/IM q24h
 
| 3 mg/kg IV/IM q24h
 
|-
 
|-
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|-
 
|-
 
| rowspan=2 | NVE
 
| rowspan=2 | NVE
| crystalline [[penicillin]] G, with or without
+
| crystalline [[penicillin]] G
 
|
 
|
 
| 4 weeks
 
| 4 weeks
 
| rowspan=2 |
 
| rowspan=2 |
 
|-
 
|-
| [[gentamicin]]
+
| ± [[gentamicin]]
 
|
 
|
 
| 2 weeks
 
| 2 weeks
 
|-
 
|-
 
| rowspan=2 | NVE
 
| rowspan=2 | NVE
| [[ceftriaxone]], with or without
+
| [[ceftriaxone]]
 
|
 
|
 
| 4 weeks
 
| 4 weeks
 
| rowspan=2 |
 
| rowspan=2 |
 
|-
 
|-
| [[gentamicin]]
+
| ± [[gentamicin]]
 
|
 
|
 
| 2 weeks
 
| 2 weeks
 
|-
 
|-
 
| rowspan=2 | PVE
 
| rowspan=2 | PVE
| crystalline [[penicillin]] G, with or without
+
| crystalline [[penicillin]] G
 
|
 
|
 
| 6 weeks
 
| 6 weeks
 
| rowspan=2 |
 
| rowspan=2 |
 
|-
 
|-
| [[gentamicin]]
+
| ± [[gentamicin]]
 
|
 
|
 
| 2 weeks
 
| 2 weeks
 
|-
 
|-
 
| rowspan=2 | PVE
 
| rowspan=2 | PVE
| [[ceftriaxone]], with or without
+
| [[ceftriaxone]]
 
|
 
|
 
| 6 weeks
 
| 6 weeks
 
| rowspan=2 |
 
| rowspan=2 |
 
|-
 
|-
| [[gentamicin]]
+
| ± [[gentamicin]]
 
|
 
|
 
| 2 weeks
 
| 2 weeks

Revision as of 21:22, 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 2 g IV q4h 6 weeks can treat for 2 weeks in uncomplicated right-sided NVE
NVE cefazolin 2 g IV q8h 6 weeks in patients with non-anaphylactoid penicillin allergy
PVE oxacillin 2 g IV q4h ≥6 weeks use cefazolin or vancomycin if allergy
+ rifampin 300 mg IV/PO q8h
+ gentamicin 1 mg/kg IV/IM q8h 2 weeks
MRSA and other oxacillin-resistant Staphylococcus
NVE vancomycin 15 mg/kg IV q12h 6 weeks target trough 10-20 μg/mL
NVE daptomycin ≥8 mg/kg/dose 6 weeks
PVE vancomycin 15 mg/kg IV q12h ≥6 weeks target vancomycin trough of 10-20 μg/mL
+ rifampin 300 mg IV/PO q8h
+ gentamicin 1 mg/kg IV/IM q8h 2 weeks
Enterococcus susceptible to penicillin and gentamicin
NVE or PVE ampicillin 2 g IV q4h 4-6 weeks 4 weeks if symptoms <3 months; 6 weeks if symptoms >3 months or if PVE
+ gentamicin 1 mg/kg IV q8h
NVE or PVE ampicillin 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 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 15 mg/kg IV q12h 6 weeks
+ gentamicin 1 mg/kg IV/IM q8h
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 IV q24h >6 weeks
Viridans Streptococcus or Streptococcus gallolyticus highly susceptible to penicillin (MIC ≤0.12 μg/mL)
NVE crystalline penicillin G 3-4 MU IV q4h 4 weeks
NVE ceftriaxone 2 g IV/IM q24h 4 weeks
NVE penicillin or ceftriaxone as above 2 weeks
+ gentamicin 3 mg/kg IV/IM q24h
NVE vancomycin 15 mg/kg IV q12h 4 weeks use if allergy, target 10-15 μg/mL
PVE crystalline penicillin G 6 MU IV q4h 6 weeks
± gentamicin 3 mg/kg IV/IM q24h 2 weeks
PVE ceftriaxone 2 g IV/IM q24h 6 weeks
± gentamicin 3 mg/kg IV/IM q24h 2 weeks
PVE vancomycin 15 mg/kg IV q12h 6 weeks use if allergy
Viridans Streptococcus or Streptococcus gallolyticus relatively resistant to penicillin (MIC >0.12 μg/mL)
NVE crystalline penicillin G 6 MU IV q4h 4 weeks
+ gentamicin 3 mg/kg IV/IM q24h
NVE vancomycin 15 mg/kg IV q12h 4 weeks use if allergy, target 10-15 μ/mL
PVE crystalline penicillin G 6 MU IV q4h 6 weeks
+ gentamicin 3 mg/kg IV/IM q24h
PVE ceftriaxone 2 g IV/IM q24h 6 weeks
+ gentamicin 3 mg/kg IV/IM q24h
PVE vancomycin 15 mg/kg IV q12h 6 weeks use if allergy
Streptococcus pneumoniae
NVE penicillin 4 weeks
NVE cefazolin 4 weeks
NVE ceftriaxone 4 weeks
PVE penicillin 6 weeks
PVE cefazolin 6 weeks
PVE ceftriaxone 6 weeks
Streptococcus pyogenes
NVE crystalline penicillin G 4 weeks
NVE ceftriaxone 4 weeks
PVE crystalline penicillin G 6 weeks
PVE ceftriaxone 6 weeks
Group B, C, or G Streptococcus
NVE crystalline penicillin G 4 weeks
± gentamicin 2 weeks
NVE ceftriaxone 4 weeks
± gentamicin 2 weeks
PVE crystalline penicillin G 6 weeks
± gentamicin 2 weeks
PVE ceftriaxone 6 weeks
± gentamicin 2 weeks
HACEK bacterium
NVE ceftriaxone 2 g IV/IM q24h 4 weeks
PVE ceftriaxone 2 g IV/IM q24h 6 weeks
NVE or PVE ciprofloxacin 500 mg PO q12h 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.