ENDOCARDITIS

Question 1

Which three organisms cause the majority of skin infections?

Answer 1

• streptococci 30-70%
• Staphylococcus 9-38%
• Enterococcus 5-18%

Question 2

What is the treatment approach to Endocarditis?

Answer 2

1. Blood cultures to isolate pathogen
2. look at sensitivity or biogram for hospital to determine which is best abx to
3. high-dose parenteral bactericidal antibiotics!! (aminoglycosides, vancomycin, cephalosporins)
4. need to get drugs into valvular vegetations and fibrin deposits

Question 3

What is the number 1 drug of choice for treatment of endocarditis?

Answer 3

Beta-lactams are #1 choice:
penicillin G IV or ceftriaxone-streptococcal
Nafcillin: staphylococcus
Ampicillin: enterococcal

Question 4

T/F Empiric therapy should be delivered before obtaining cultures

Answer 4

False

Question 5

How many blood cultures should be obtained before starting empiric treatment?

Answer 5

at least 2

-preferably 3

Question 6

T/F Large doses of parenteral antibiotics are more successful in reaching bacteria within vegetations than oral antibiotics

Answer 6

True

Question 7

What is empiric treatment for native valves?

Answer 7

Vancomycin + Ceftriaxzone

Question 8

What is empiric treatment for prosthetic valves?

Answer 8

Vancomycin + Rifampin+ Gentamicin

Question 9

What is most common infection in IVDA? Which valve is most infected?

Answer 9

• Staphylococcus

- Tricuspid

Question 10

What is antibiotic treatment for native valve methicillin sensitive staphylococcus?

Answer 10

• Nafcillin/Oxacillin or Cefazolin

- 6 weeks

Question 11

What is antibiotic treatment for native valve methicillin resistant staphylococcus?

Answer 11

vancomycin or daptomycin

-6 weeks

Question 12

What is antibiotic treatment for prosthetic valve methicillin sensitive staphylococcus?

Answer 12

Nafcillin/Oxacillin or Cefazolin
+ Gentamicin + Rifampin
-Total 6 weeks

Question 13

What is antibiotic treatment for prosthetic valve methicillin resistant staphylococcus?

Answer 13

Vancomycin +Rifampin + Gentamicin (2)

-total 6 weeks

Question 14

Which bacteria is cause of sub acute endocarditis?

Answer 14

-Streptococcus

Question 15

What is antibiotic treatment for native valve penicillin sensitive streptococcus viridans?

Answer 15

• penicillin or Ampicillin or Cetriaxzone-4 weeks
• Penicillin G + Gentamicin -2 week regimen
• Beta-lactam intolerant: vancomycin

Question 16

What is antibiotic treatment for native valve penicillin resistant streptococcus?

Answer 16

IV Penicillin G or Ampicillin - 4 week
+ Gentamicin- 2 weeks

or Monotherapy with Vancomycin or Ceftriaxzone-4 weeks

Question 17

What are ADE of daptomycin?

Answer 17

• rhabdomylosis

- myoptahy

Question 18

What should you monitor for Daptomycin?

Answer 18

-CPK

Question 19

What are contraindication for daptomycin?

Answer 19

• renal dysfunction

- patients taking HMG CoA reductase

Question 20

What are ADE of gentamicin?

Answer 20

• nephrotoxicity
• ototoxicity
• neuromuscular blockade

Question 21

What are contraindications to Gentamicin?

Answer 21

• NSAIDS

- diuretics

Question 22

What are ADE of Linezolid?

Answer 22

• retinal-peripheral neuropathy

- thrombocytopenia

Question 23

What should you monitor on Linezolid?

Answer 23

• platelets

- visual changes

Question 24

What are ADE of Rifampin?(2)

Answer 24

Hepatotoxicity

-orange discoloration of urine or sweat

Question 25

What should you monitor with Rifampin

Answer 25

LFT's

Question 26

What are ADE of vancomycin? (2)

Answer 26

- Red man syndrome | - Nephrotoxicity

Question 27

What are indications for prophylactic treatment for IE (4)?

Answer 27

- before dental procedures or invasive respiratory procedures in the following - previous IE - prosthetic cardiac valves - repaired or unrepaired congenital heart defects - cardiac transplant with valve regurgitation

Question 28

What is prophylactic tx for IE

Answer 28

- 2g of oral amoxicillin - 2g of oral cephalexin - oral clindamycin 600mg