ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Treatment regimens for NVE due to strains of viridans streptococci and Streptococcus gallolyticus (bovis) relatively resistant to penicillin G*

Treatment regimens for NVE due to strains of viridans streptococci and Streptococcus gallolyticus (bovis) relatively resistant to penicillin G*
American Heart Association (AHA)

 European Society of Cardiology (ESC)

(MIC >0.125 and <2 mcg/mL)*

British Society for Antimicrobial Chemotherapy (BSAC)

(MIC >0.125 and <0.5 mcg/mL)*

Adult

(MIC >0.12 and <0.5 mcg/mL)*

Pediatric

(MIC >0.1 and <0.5 mcg/mL)*

Combination: 

Either

Aqueous penicillin G 24 million units per 24 hours IV either continuously or in 4 or 6 divided doses for 4 weeks

or

AmpicillinΔ 2 g IV every 4 hours for 4 weeks

plus

Gentamicin◊ 3 mg/kg per 24 hours IV or IM in 1 dose for first 2 weeks

or

Monotherapy:

Either

Vancomycin§ 30 mg/kg per 24 hours IV in 2 divided doses for 4 weeks

or

CeftriaxoneΔ 2 g per 24 hours IV or IM in 1 dose for 4 weeks

Combination: 

Either 

Aqueous penicillin G 200,000 to 300,000 units/kg per 24 hours IV in 6 divided doses (maximum dose: 24 million units per 24 hours) for 4 weeks

or

Ampicillin 200 to 300 mg/kg per 24 hours IV divided in 4 or 6 divided doses (maximum dose: 12 g per 24 hours) for 4 weeks

or

Ceftriaxone 100 mg/kg per 24 hours IV​† in 2 divided doses or 80 mg/kg in 1 daily dose (maximum dose: 4 g per 24 hours; if dose is >2 g per 24 hours, use divided dosing every 12 hours) for 4 weeks

plus

Gentamicin◊ 3 to 6 mg/kg per 24 hours IV in 3 divided doses for first 2 weeks

 

Beta-lactam-intolerant patients:

Vancomycin§ 40 mg/kg per 24 hours IV in 2 or 3 divided doses (maximum dose: 2 g per 24 hours unless levels are inappropriately low) plus gentamicin (dosing as above) for 4 weeks

 

Combination: 

Either

Aqueous penicillin G 24 million units per 24 hours IV in 4 or 6 divided doses or continuous infusion for 4 weeks

or

Amoxicillin 200 mg/kg per 24 hours IV in 4 or 6 divided doses for 4 weeks

or

Ampicillin 12 g per 24 hours (200 mg/kg per 24 hours) in 6 divided doses for 4 weeks

or

Ceftriaxone¥ 2 g per 24 hours IV or IM in 1 dose for 4 weeks

plus

Gentamicin◊¥ 3 mg/kg per 24 hours IV or IM in 1 dose for 2 weeks

OR

Vancomycin§ 30 mg/kg per 24 hours IV in 2 divided doses for 4 weeks

plus

Gentamicin◊ 3 mg/kg per 24 hours IV or IM in 1 dose for first 2 weeks

Combination: 

Benzylpenicillin‡ 2.4 g every 4 hours IV for 4 to 6 weeks

plus

Gentamicin◊ 1 mg/kg every 12 hours IV for 2 weeks
The doses above are intended for patients with normal renal function. The doses of many of these agents must be adjusted in the setting of renal insufficiency; refer to the individual Lexicomp drug monographs for renal dose adjustments.
​Wherever intramuscular administration is provided as an alternative, intravenous route is preferred, particularly in infants and children.
NVE: native valve endocarditis; MIC: minimum inhibitory concentration; IV: intravenously; IM: intramuscularly.
* MIC thresholds differ between guidelines, as summarized above. Patients with infective endocarditis due to isolates with MICs that exceed these thresholds should receive treatment as for enterococcal infective endocarditis, as summarized in separate tables.
¶ Pediatric doses (should not exceed adult doses): Penicillin G 200,000 units/kg per 24 hours IV in 4 to 6 divided doses; amoxicillin 300 mg/kg per 24 hours IV in 4 to 6 divided doses; ceftriaxone 100 mg/kg per dose IV or IM daily; vancomycin 40 mg/kg per 24 hours IV in 2 or 3 divided doses; gentamicin 3 mg/kg per 24 hours IV or IM in a single daily dose or in 3 divided doses.
Δ Ampicillin plus gentamicin and ceftriaxone monotherapy are alternatives to the other regimens listed.
◊ Renal function and gentamicin serum concentrations should be monitored at least once per week. Gentamicin dosage adjusted for peak serum concentration 3 to 4 mcg/mL, trough <1 mcg/mL when 2 to 3 divided doses used; when given in a single daily dose, pre-dose (trough) concentrations should be <1 mcg/mL. Per ESC guidelines, post-dose (peak, 1 hour after injection) serum concentrations should be approximately 10 to 12 mcg/mL (per AHA guidelines, there is no role for measuring peak gentamicin concentration following single daily dosing).
§ Vancomycin therapy only recommended for patients allergic to penicillins and cephalosporins; dose adjusted for trough concentration of 10 to 15 mcg/mL. Penicillin desensitization can be attempted in stable patients.
¥ Preferred for outpatient therapy.
‡ Amoxicillin 2 g every 4 to 6 hours may be used in place of benzylpenicillin 1.2 to 2.4 g every 4 hours.
† In infants and children, intravenous antibiotics are recommended rather than intramuscular agents.
Data from:
  1. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications: A scientific statement for healthcare professionals from the American Heart Association. Circulation 2015; 132:1435.
  2. Baltimore RS, Gewitz M, Baddour LM, et al. Infective Endocarditis in Childhood: 2015 Update: A Scientific Statement From the American Heart Association. Circulation 2015; 132:1487.
  3. Authors/Task Force Members, Habib G, Lancellotti P, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075.
  4. Gould FK, Denning DW, Elliott TS, et al. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2012; 67:269.
Graphic 53990 Version 19.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟