Antimicrobial Treatment in Infective Endocarditis

Question 1

________ and _______ are used in the empiric treatment of bacterial IE

Answer 1

vancomycin and gentamicin

Question 2

in addition to the empirical treatment antimicrobials, what would you add to treatment in a person suffering from prosthetic valve IE?

Answer 2

Rifampin

Question 3

when would you add rifampin to the empirical regiment of _____ and _____ in treating IE?

Answer 3

vancomycin and gentamicin;

in patients with prosthetic valve IE

Question 4

patient with IE is taking vancomycin but it is not working. What drug would you prescribe next?

Answer 4

linezolid or daptomycin

Question 5

patients suffering from IE are usually given ______ and ____ via _____

Answer 5

vancomycin and gentamicin via IV

Question 6

what is the antibacterial treatment for IE caused by α hemolytic streptococci?

Answer 6

• penicillins (Penicillin G and ampicillin) often in combination with gentamicin
• IV ceftraixone (alone or with gentamicin)
  pencillins + gentamicin

Question 7

patient who is allergic to penicillin is suffering from IE caused by an α hemolytic streptococci. What would you give to treat them?

Answer 7

vancomycin

Question 8

when treating IE caused by Staph aureus, what are 3 situations you need to account for in choosing the antimicrobial drugs

Answer 8

• oxacillin suspectible strains of SA
• oxacillin resistant strains of SA
• patients who are allergic to penicillins

Question 9

what would you give to treat someone who has IE caused by staph aureus that is susceptible to oxacillin?

Answer 9

• nafcillin or oxacillin

Question 10

what would you give to someone who has IE caused by staph aureus that is resistant to oxacillin?

Answer 10

• vancomycin

Question 11

what would you give to someone suffering from IE caused by Staph aureus and is allergic to penicillin

Answer 11

cefazolin

Question 12

what cardiac conditions is prophylactic treatment for bacterial endocarditis recommend for?

Answer 12

• prosthetic valves
• previous history of infective endocarditis
• congenital heart disease
• cardiac transplant recipients with valvulopathy

Question 13

what is the standard regiment of bacterial endocarditis prophylaxis

Answer 13

• amoxicillin (oral)

Question 14

a patient is going to undergo a dental procedure and they are allergic to penicillin. What would you given them for prophylaxis for bacterial IE?

Answer 14

• clindamycin
• cephalexin
• azithromycin
• clarithromycin
  all are given orally

Question 15

if a patient refuses to take oral medication, what would you give them for prophylaxis of bacterial IE?

Answer 15

• ampicillin via IM / IV

Question 16

patient is allergic to penicillin AND cannot take drugs orally. what would you give for prophylaxis of bacterial IE?

Answer 16

clindamycin IV or cefazolin IV

Question 17

when do you actually administer prophylactic treatment for bacterial IE?

Answer 17

• single dose of antibiotics 1h before procedure