Disease / Etiology
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Preferred
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Alternative
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Comments
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Infective Endocarditis
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Native valve, Non IVDU
Strep viridans
Other Streptococci
Enterococcus
Staphylococcus
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Benzylpenicillin 50,000 units/kg IV q4H for 4 weeks
+ Gentamicin 1 mg/kg q8H IV for 2 weeks
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Penicillin allergy: Vancomycin 15 - 20 mg/kg IV q8H for 4 - 6 weeks
+ Gentamicin 1 mg/kg IV q8H for 2 weeks
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At least 3 sets of blood cultures from different sites before empiric therapy.
Gentamicin added to beta lactam clears culture earlier but does not change mortality. Avoid in elderly and renal impaired. Discontinue once cultures known except for streptococcal and enterococcal endocarditis. |
Native valve, IVDU
Right sided endocarditis:
Staphylococcus aureus (MSSA, MRSA)
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For MSSA IE:
Cloxacillin 50 mg/kg IV q6H for 6 weeks
+ Gentamicin 1 mg/kg q8H for 2 weeks
For MRSA IE:
Vancomycin (Monotherapy)
15 - 20 mg/kg IV q8H for 4 - 6 weeks
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For MSSA IE:
Cefazolin 25 mg/kg q8H IV for 6 weeks
+ Gentamicin 1 mg/kg IV q8H for 2 weeks
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Prosthetic valve endocarditis:
S epidermidis (MSSE / MRSE)
S viridans
Staph aureus
Rarely,
Enterobacteriaceae
Diphtheroids
Fungi
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Vancomycin
15 - 20 mg/kg q8H IV for 6 weeks
+ Rifampicin 20 mg/kg/day (max 600 mg/day) PO in 3 divided doses for 6 weeks
+ Gentamicin 1 mg/kg IV q8H for 2 weeks
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Pericarditis (Purulent)
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Staph aureus
Strep pneumoniae
Haemophilus influenzae
Other Streptococci
Gram negative bacteria
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Cloxacillin 50 mg/kg IV q6H for 4 - 6 weeks
+ Gentamicin 1 mg/kg IV q8H for 2 weeks
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Vancomycin 15 - 20 mg/kg IV q8H for 4 - 6 weeks
+ Gentamicin 1 mg/kg IV q8H for 2 weeks |
Duration: minimum 4 weeks
Early surgical consult for possibly intervention. Ceftriaxone / Cefotaxime may be considered in place of Gentamicin. |
Rheumatic Fever
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With carditis. Post infectious sequelae of Group A strep infection (usually pharyngitis). |
Benzylpenicillin 50,000 units/kg IV q6H for 10 - 14 days
OR
Penicillin V 10 - 15 mg/kg PO q6H for 10 - 14 days
Followed by Penicillin V prophylaxis:
<5 years old 125 mg BD
>5 years old 250 mg BD
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Penicillin allergy:
Erythromycin: 12.5 mg/kg PO q6H for 10 - 14 days followed by Erythromycin 12.5 mg/kg PO q12H
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Mild / No carditis:
Aspirin 80 - 100 mg/kg/day in 3 - 4 divided doses for 2 - 4 weeks then taper over 4 weeks.
Moderate / Severe carditis:
Prednisolone 2 mg/kg/day in 2 divided doses for 2 - 4 weeks then taper over 2 weeks with addition of Aspirin as above.
# Please refer to the appropriate Rheumatic Fever Guideline for the management of carditis.
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Pacemaker / Defibrillator & Ventricular Assist Device Related Infection
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S aureus
S epidermidis
Aerobic gram negative bacilli
Fungal
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Vancomycin
15 - 20 mg/kg IV q8H for 6 weeks
+ Gentamicin 1 mg/kg IV q8H for 2 weeks
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Linezolid (Monotherapy)
10 mg/kg IV q8H for 4 - 6 weeks |
IV to PO switch possible after clinical improvement.
Fungal infection rare. For proven fungal infections Amphotericin B or Voriconazole equally effective.
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Infective Endocarditis Prophylaxis Guideline for Dental Procedure
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Viridans group streptococci |
Oral:
Amoxicillin 50 mg/kg
(60 minutes before procedure)
Parenteral (IV or IM):
Ampicillin 50 mg/kg
OR
Cefazolin / Ceftriaxone
50 mg/kg
(30 minutes before procedure)
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Single dose
Oral:
Clindamycin 20 mg/kg
(60 minutes before procedure)
OR
Cephalexin 50 mg/kg
(30 - 60 minutes before procedure)
OR
Azithromycin / Clarithromycin 15 mg/kg
(30 - 60 minutes before procedure)
Parenteral (IV / IM):
Clindamycin 20 mg/kg
(30 minutes before procedure)
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Cardiac conditions in which prophylaxis for dental procedures is recommended.
1. Prosthetic cardiac valve
2. Previous IE
3. Unrepaired cyanotic CHD, including palliative shunts and conduits
4. Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure
5. Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
6. Cardiac transplantation recipients who develop cardiac valvulopathy
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