34 Infective Endocarditis
BUY
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Infective Endocarditis
1. Admit to:
2. Diagnosis: Infective endocarditis
3. Condition:
4. Vital signs: q4h. Call physician if BP systolic >160/90, <90/60; P >120, <50;
R>25, <10; T >38.5
C
5. Activity: Up ad lib
6. Diet: Regular
7. IV Fluids: Heparin lock with flush q shift.
8. Special Medications:
Subacute Bacterial Endocarditis Empiric Therapy:
-Penicillin G 3-5 million U IV q4h or ampicillin 2 gm IV q4h AND
Gentamicin 1-1.5/mg/kg IV q8h.
Acute Bacterial Endocarditis Empiric Therapy
-Gentamicin 2 mg/kg IV; then 1-1.5 mg/kg IV q8h AND
Nafcillin or oxacillin 2 gm IV q4h OR
Vancomycin 1 gm IV q12h (1 gm in 250 mL of D5W over 1h).
Streptococci viridans/bovis:
-Penicillin G 3-5 million U IV q4h for 4 weeks OR
Vancomycin 1 gm IV q12h for 4 weeks AND
Gentamicin 1 mg/kg q8h for first 2 weeks.
Enterococcus:
-Gentamicin 1 mg/kg IV q8h for 4-6 weeks AND
Ampicillin 2 gm IV q4h for 4-6 weeks OR
Vancomycin 1 gm IV q12h for 4-6 weeks.
Staphylococcus aureus (methicillin sensitive, native valve):
-Nafcillin or Oxacillin 2 gm IV q4h for 4-6 weeks OR
Vancomycin 1 gm IV q12h for 4-6 weeks AND
Gentamicin 1 mg/kg IV q8h for first 3-5 days.
Methicillin resistant Staphylococcus aureus (native valve):
-Vancomycin 1 gm IV q12h (1 gm in 250 mL D5W over 1h) for 4-6 weeks
AND
Gentamicin 1 mg/kg IV q8h for 3-5 days.
Methicillin resistant Staph aureus or epidermidis (prosthetic valve):
-Vancomycin 1 gm IV q12h for 6 weeks AND
Rifampin 600 mg PO q8h for 6 weeks AND
Gentamicin 1 mg/kg IV q8h for 2 weeks.
Culture Negative Endocarditis:
-Penicillin G 3-5 million U IV q4h for 4-6 weeks OR
Ampicillin 2 gm IV q4h for 4-6 weeks AND
Gentamicin 1.5 mg/kg q8h for 2 weeks (or nafcillin, 2 gm IV q4h, and gen-
tamicin if Staph aureus suspected in drug abuser or prosthetic valve).
Fungal Endocarditis:
-Amphotericin B 0.5 mg/kg/d IV plus flucytosine (5-FC) 150 mg/kg/d PO.
9. Extras: CXR PA and LAT, echocardiogram, ECG.
11. Labs: CBC with differential, SMA 7&12. Blood C&S x 3-4 over 24h, serum
