Sandbox-ID-Cardiovascular

# Cardiovascular
- Endocarditis, prophylaxis Return to Top
- 1. Dental procedures that involve manipulation of gingival tissue, manipulation of the periapical region of teeth, or perforation of the oral mucosa (including scaling and root canal procedures)
- 1.1 Indications
- Patients with a prosthetic valve or a prosthetic material used for cardiac valve repair
- Patients with previous IE
- Cardiac transplant recipients with valve regurgitation due to a structurally abnormal valve
- Patients with congenital heart disease:
- Unrepaired cyanotic CHD with palliative shunts, conduits, or other prostheses
- Completely repaired CHD repaired with prosthetic material or device, whether placed by surgery or catheter intervention, during the first 6 months after the procedure
- Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device
- 1.2 Prophylactic regimens (single dose 3060 minutes before procedure)
- 1.2.1 Adults
- Antibiotic Prophylactic Regimens for Dental Procedures
- Oral regimen
- Preferred regimen: Amoxicillin 2 g single dose 30-60 minutes before procedure.
- Pediatric dose: Amoxicillin 50 mg/kg single dose 30-60 minutes before procedure.
- Unable to take oral medication
- Preferred regimen: Ampicillin 2 g IM or IV single dose 30-60 minutes before procedure OR Cefazolin 1 g IM or IV single dose 30-60 minutes before procedure OR Ceftriaxone 1 g IM or IV single dose 30-60 minutes before procedure.
- Pediatric dose: Ampicillin 50 mg/kg; Cefazolin 50 mg/kg; Ceftriaxone 50 mg/kg
- Allergic to penicillins or ampicillin Oral regimen
- Preferred regimen: Cephalexin 2 g single dose 30-60 minutes before procedure OR Clindamycin 600 mg single dose 30-60 minutes before procedure OR Azithromycin 500 mg single dose 30-60 minutes before procedure OR Clarithromycin 500 mg  single dose 30-60 minutes before procedure.
- Pediatric dose:  Cephalexin 50 mg/kg single; Clindamycin 20 mg/kg; Azithromycin 15 mg/kg OR Clarithromycin 15 mg/kg.
- Allergic to penicillins or ampicillin and unable to take oral medication
- Preferred regimen: Cefazolin 1 g IM or IV single dose 30-60 minutes before procedure OR Ceftriaxone 1 g IM or IV single dose 30-60 minutes before procedure OR Clindamycin 600 mg IM or IV.
- Pediatric dose: Cefazolin 50 mg/kg IM or IV OR Ceftriaxone 20 mg/kg IM or IV.
- Gastrointestinal/Genitourinary Procedures
- Antibiotic prophylaxis solely to prevent IE is no longer recommended for patients who undergo a GI or GU tract procedure.
- Regimens for Respiratory Tract Procedures
- Oral regimen
- Preferred regimen: Amoxicillin 2 g single dose 30-60 minutes before procedure.
- Pediatric dose: Amoxicillin 50 mg/kg single dose 30-60 minutes before procedure.
- Unable to take oral medication
- Preferred regimen: Ampicillin 2 g IM or IV OR Cefazolin 1 g IM or IV OR Ceftriaxone 1 g IM or IV.
- Pediatric dose: Ampicillin 50 mg/kg; Cefazolin 50 mg/kg; Ceftriaxone 50 mg/kg.
- Allergic to penicillins or ampicillin Oral regimen
- Preferred regimen: Cephalexin 2 g single dose 30-60 minutes before procedure OR Clindamycin 600 mg single dose 30-60 minutes before procedure OR Azithromycin 500 mg single dose 30-60 minutes before procedure OR Clarithromycin 500 mg  single dose 30-60 minutes before procedure.
- Pediatric dose:  Cephalexin 50 mg/kg single; Clindamycin 20 mg/kg; Azithromycin or Clarithromycin 15 mg/kg.
- Allergic to penicillins or ampicillin and unable to take oral medication
- Preferred regimen: Cefazolin 1 g OR ceftriaxone 1 g IM or IV single dose 30-60 minutes before procedure OR Clindamycin 600 mg IM or IV.
- Pediatric dose: Cefazolin 50 mg/kg IM or IV OR Ceftriaxone 20 mg/kg IM or IV.
- Regimens for Procedures on Infected Skin, Skin Structure, or Musculoskeletal Tissue
- Patients who undergo a surgical procedure that involves infected skin, skin structure, or musculoskeletal tissue, it may be reasonable that the therapeutic regimen administered for treatment of the infection contain an agent active against staphylococci and -hemolytic streptococci, such as an antistaphylococcal penicillin or a cephalosporin.
- Aortitis, infectious Return to Top
- Infectious aortitis
- 1. Causative pathogens
- Salmonella
- Staphylococcus aureus
- Group A Streptococcus
- Streptococcus pneumoniae
- Haemophilus influenzae
- Escherichia coli or other Gram-negative bacilli
- Fungi
- 2. Empiric antimicrobial therapy
- Preferred regimen: (Cefotaxime 12 g IV q68h for 612 weeks OR Ceftriaxone 12 g IV q24h for 612 weeks OR Ciprofloxacin 400 mg IV q12h for 612 weeks OR Ciprofloxacin 500750 mg PO bid for 612 weeks OR Levofloxacin 250750 mg IV/PO q24h for 612 weeks) AND (Oxacillin 12 g IV/IM q46h for 612 weeks OR Nafcillin 12 g IV/IM q46h for 612 weeks OR Dicloxacillin 0.51.0 g IV q46h for 612 weeks OR Vancomycin 1 g IV q12h for 612 weeks)
- Note: Antimicrobial treatment with bactericidal, broad-spectrum agents should be administered after obtaining blood cultures and prior to surgery as soon as the diagnosis is suspected and adjusted as needed based on culture results.
- Cardiovascular implantable electronic device infections Return to Top
- Cardiovascular implantable electronic device (CIED) infections
- 1. Definitions
- 1.1 Early post-implantation inflammation
- Erythema affecting the box implantation incision site, without purulent exudate, dehiscence, fluctuance or systemic signs of infection and occurring within 30 days of implantation
- 1.2 Uncomplicated generator pocket infection
- (a) Spreading cellulitis affecting the generator site; OR (b) incision site purulent exudate (excluding simple stitch abscess); OR (c) wound dehiscence; OR (d) erosion through skin with exposure of the generator or leads; OR (e) fluctuance (abscess) or fistula formation; AND no systemic symptoms or signs of infection AND negative blood cultures
- 1.3 Complicated generator pocket infection
- As for uncomplicated generator pocket infection but WITH evidence of lead or endocardial involvement, systemic signs or symptoms of infection or positive blood cultures.
- 1.4 CIED lead infection (CIED-LI)
- 1.4.1 Definite CIED-LI
- (a) Symptoms/signs of systemic infection, NO signs of generator pocket infection AND echocardiography consistent with vegetation(s) attached to lead(s) AND presence of major Duke microbiological criteria; OR (b) Symptoms/signs of systemic infection, NO signs of generator pocket infection AND culture, histology or molecular evidence of infection on explanted lead
- 1.4.2 Possible CIED-LI
- (a) Symptoms/signs of systemic infection AND echocardiography consistent with vegetation(s) attached to lead(s) BUT no major Duke microbiological criteria present; OR (b) Symptoms/signs of systemic infection AND major Duke microbiological criteria present BUT no echocardiographic evidence of lead vegetations
- 1.5 CIED-associated native or prosthetic valve endocarditis (CIED-IE)
- Duke criteria for definite endocarditis satisfied, with echocardiographic evidence of valve involvement, in a patient with an CIED in situ
- 2. Duration of antimicrobial therapy
- 2.1 Early post-implantation inflammation
- Consider observation or PO therapy 710 days
- 2.2 Uncomplicated generator pocket infection AND no absolute requirement for CIED AND device removable
- 1014 days IV/PO therapy
- 2.3 Uncomplicated generator pocket infection AND absolute requirement for CIED AND device removable
- 1014 days IV therapy
- 2.4 Generator pocket infection when attempted lead extraction considered too risky or declined by patient AND no absolute requirement for CIED
- 6 weeks IV therapy
- 2.5 Generator pocket infection when attempted extraction considered too risky or declined by patient AND absolute requirement for CIED
- 6 weeks IV therapy
- 2.6 CIED-IE (with or without clinical evidence of generator pocket infection) AND no absolute requirement for CIED AND device removable
- 2.6.1 Native valves affected
- 4 weeks IV therapy
- 2.6.2 Prosthetic valves affected, secondary brain abscess or spinal infection
- 6 weeks IV therapy
- 2.7 CIED-LI (with or without clinical evidence of generator pocket infection or IE) AND no absolute requirement for CIED AND device removable
- Prolonged therapy post removal is not usually required.
- 2.8 CIED-IE or CIED-LI (without generator pocket infection) when extraction considered too risky or declined by patient AND absolute requirement for CIED
- 6 weeks IV therapy
- 3. Empiric antimicrobial therapy
- 3.1 Early post implantation inflammation
- Preferred regimen: Flucloxacillin 0.51 g PO qid
- Alternative regimen (penicillin allergy or MRSA colonisation): Doxycycline 100 mg PO bid OR Linezolid 600 mg PO bid OR Clindamycin 450 mg PO qid
- 3.2 Uncomplicated generator pocket infection
- Preferred regimen: Vancomycin 1 g IV q12h OR Daptomycin 4 mg/kg IV q24h OR Teicoplanin 6 mg/kg IV at 0, 12, and 24 h and then q24h
- 3.3 CIED-LI or CIED-IE or complicated generator pocket infection pending blood cultures, e.g. in severe sepsis
- Preferred regimen: (Vancomycin 1 g IV q12h OR Daptomycin 810 mg/kg IV q24h) AND Meropenem 1 g IV q8h
- 3.4 CIED-LI or CIED-IE or generator pocket vancomycin infection with negative blood cultures
- Preferred regimen: (Vancomycin 1 g IV q12h OR Daptomycin 810 mg/kg IV q24h) AND Gentamicin 1 mg/kg IV q12h
- Note: Select antimicrobial therapy based on identification and in vitro susceptibility of infecting pathogen.
- 4. Culture-directed antimicrobial therapy
- 4.1 Uncomplicated generator pocket infections or CIED-LI/generator pocket infections assuming device removal
- 4.1.1 Staphylococcus aureus
- 4.1.1.1 Methicillin-susceptible strains
- Preferred regimen: Flucloxacillin 2 g PO q6h
- 4.1.1.2 Methicillin-resistant or penicillin-allergic patients
- Preferred regimen: Vancomycin 1 g IV q12h OR Daptomycin 4 mg/kg IV q24h OR Teicoplanin 6 mg/kg IV at 0, 12, and 24 h and then q24h
- 4.1.2 Streptococcus
- 4.1.2.1 Penicillin-susceptible strains
- Preferred regimen: Penicillin G 1.2 g IV q4h
- 4.1.2.2 Penicillin-resistant strains or penicillin-allergic patients
- Preferred regimen: Vancomycin 1 g IV q12h OR Teicoplanin 6 mg/kg IV at 0, 12, and 24 h and then q24h
- 4.1.3 Enterococcus
- 4.1.3.1 Amoxicillin-susceptible strains
- Preferred regimen: Amoxicillin 2 g IV q6h
- 4.1.3.2 Amoxicillin-resistant but vancomycin-susceptible strains, or penicillin-allergic patients
- Preferred regimen: Vancomycin 1 g IV q12h OR Teicoplanin 6 mg/kg IV at 0, 12, and 24 h and then q24h
- 4.1.3.3 Amoxicillin-resistant, vancomycin-resistant, but daptomycin-susceptible strains
- Preferred regimen: Daptomycin 4 mg/kg IV q24h OR Linezolid 600 mg PO bid
- 4.1.4 Enterobacteriaceae
- Case-by-case depending on susceptibility, monotherapy advised
- 4.2 CIED-IE when system can be removed and no prosthetic valves are involved
- 4.2.1 Staphylococcus aureus
- 4.2.1.1 Methicillin-susceptible strains
- Preferred regimen: Flucloxacillin 2 g PO q6h
- 4.2.1.2 Methicillin-resistant, glycopeptide-susceptible strains, or penicillin-allergic patients
- Preferred regimen: (Vancomycin 1 g IV q12h OR Teicoplanin 6 mg/kg IV at 0, 12, and 24 h and then q24h) AND (Rifampin 600 mg PO q12h OR Gentamicin 1 mg/kg IV q12h)
- 4.2.1.3 Glycopeptide-resistant strains, or vancomycin-intolerant patients, or where nephrotoxicity is a concern
- Preferred regimen: Daptomycin 4 mg/kg IV q24h AND (Rifampin 600 mg PO q12h OR Gentamicin 1 mg/kg IV q12h)
- 4.2.2 Streptococcus
- 4.2.2.1 Penicillin-susceptible strains
- Preferred regimen: Penicillin G 1.2 g IV q4h AND Gentamicin 1 mg/kg IV q12h
- 4.2.2.2 Penicillin-resistant strains or penicillin-allergic patients
- Preferred regimen: (Vancomycin 1 g IV q12h OR Teicoplanin 6 mg/kg IV at 0, 12, and 24 h and then q24h) AND Gentamicin 1 mg/kg IV q12h
- 4.2.3 Enterococcus
- 4.2.3.1 Penicillin and gentamicin-susceptible strains
- Preferred regimen: Amoxicillin 2 g IV q4h AND Gentamicin 1 mg/kg IV q12h
- 4.2.3.2 Penicillin-resistant strains or penicillin-allergic patients
- Preferred regimen: (Vancomycin 1 g IV q12h OR Teicoplanin 6 mg/kg IV at 0, 12, and 24 h and then q24h) AND Gentamicin 1 mg/kg IV q12h
- 4.2.3.3 Vancomycin-resistant, daptomycin-susceptible strains or glycopeptide-allergic/intolerant patients
- Preferred regimen: Daptomycin 4 mg/kg IV q24h AND (Gentamicin 1 mg/kg IV q12h OR Amoxicillin 2 g IV q4h OR Linezolid 600 mg IV/PO q12h)
- 4.2.4 Enterobacteriaceae
- Preferred regimen: Meropenem 1 g IV q8h AND Gentamicin 1 mg/kg IV q12h
- 4.3 CIED-IE or CIED-LI or complicated generator pocket infection when entire system CANNOT be removed or prosthetic valves are involved
- 4.3.1 Staphylococcus aureus
- 4.3.1.1 Methicillin-susceptible strains
- Preferred regimen: Flucloxacillin 2 g PO q6h AND Rifampin 600 mg PO q12h AND Gentamicin 1 mg/kg IV q12h
- 4.3.1.2 Methicillin-resistant, glycopeptide-susceptible strains, or penicillin-allergic patients
- Preferred regimen: (Vancomycin 1 g IV q12h OR Teicoplanin 6 mg/kg IV at 0, 12, and 24 h and then q24h) AND (Rifampin 600 mg PO q12h OR Gentamicin 1 mg/kg IV q12h)
- 4.3.1.3 Glycopeptide-resistant strains, vancomycin-intolerant patients, or where nephrotoxicity is a concern
- Preferred regimen: Daptomycin 4 mg/kg IV q24h AND Rifampin 600 mg PO q12h AND Gentamicin 1 mg/kg IV q12h
- 4.3.2 Streptococcus
- 4.3.2.1 Penicillin-susceptible strains
- Preferred regimen: Penicillin G 1.2 g IV q4h AND Gentamicin 1 mg/kg IV q12h
- 4.3.2.2 Penicillin-resistant strains or penicillin-allergic patients
- Preferred regimen: (Vancomycin 1 g IV q12h OR Teicoplanin 6 mg/kg IV at 0, 12, and 24 h and then q24h) AND Gentamicin 1 mg/kg IV q12h
- 4.3.3 Enterococcus
- 4.3.3.1 Penicillin-susceptible strains
- Preferred regimen: Amoxicillin 2 g IV q4h AND Gentamicin 1 mg/kg IV q12h
- 4.3.3.2 Penicillin-resistant or penicillin-allergic patients
- Preferred regimen: (Vancomycin 1 g IV q12h OR Teicoplanin 6 mg/kg IV at 0, 12, and 24 h and then q24h) AND Gentamicin 1 mg/kg IV q12h
- 4.3.3.3 Vancomycin-resistant, daptomycin-susceptible strains, or glycopeptide-allergic/intolerant patients
- Preferred regimen: Daptomycin 4 mg/kg IV q24h AND (Gentamicin 1 mg/kg IV q12h OR Amoxicillin 2 g IV q4h OR Linezolid 600 mg IV/PO q12h)
- 4.3.4 Enterobacteriaceae
- Preferred regimen: Meropenem 1 g IV q8h AND Gentamicin 1 mg/kg IV q12h
- Endocarditis, prophylaxis Return to Top
- Endocarditis, treatment Return to Top
- Infective endocarditis
- Culture-negative endocarditis
- Culture-negative, native valve endocarditis
- Preferred regimen: Ampicillin-sulbactam 12 g/24h IV q6h 46 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 46 weeks
- Alternative regimen: Vancomycin 30 mg/kg/24h IV q12h for 46 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 46 weeks AND Ciprofloxacin 1000 mg/24h PO or 800 mg/24h IV q12h for 46 weeks
- Pediatric dose: Ampicillin-sulbactam 300 mg/kg/24h IV q46h; Gentamicin 3 mg/kg/24h IV/IM q8h; Vancomycin 40 mg/kg/24h q812h; Ciprofloxacin 2030 mg/kg/24h IV/PO q12h
- Culture-negative, prosthetic valve endocarditis (early,  1 year)
- Preferred regimen : Vancomycin 30 mg/kg/24h IV q12h for 6 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 2 weeks AND Cefepime 6 g/24h IV q8h for 6 weeks AND Rifampin 900 mg/24h PO/IV q8h for 6 weeks
- Pediatric dose: Vancomycin 40 mg/kg/24h IV q812h; Gentamicin 3 mg/kg/24h IV/IM q8h; Cefepime 150 mg/kg/24h IV q8h; Rifampin 20 mg/kg/24h PO/IV q8h
- Culture-negative, prosthetic valve endocarditis (late, > 1 year)
- Preferred regimen: Ampicillin-sulbactam 12 g/24h IV q6h 6 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 6 weeks
- Alternative regimen: Vancomycin 30 mg/kg/24h IV q12h for 46 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 6 weeks AND Ciprofloxacin 1000 mg/24h PO or 800 mg/24h IV q12h for 6 weeks
- Pediatric dose: Ampicillin-sulbactam 300 mg/kg/24h IV q4h; Gentamicin 3 mg/kg/24h IV/IM q8h; Vancomycin 40 mg/kg/24h q812h; Ciprofloxacin 2030 mg/kg/24h IV/PO q12h
- Culture-negative, prosthetic valve endocarditis (early,  1 year)
- Preferred regimen: Ampicillin-sulbactam 12 g/24h IV q6h 46 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 46 weeks AND Rifampin 900 mg/24h PO/IV q8h for 6 weeks
- Alternative regimen: Vancomycin 30 mg/kg/24h IV q12h for 46 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 46 weeks AND Ciprofloxacin 1000 mg/24h PO or 800 mg/24h IV q12h for 46 weeks AND Rifampin 900 mg/24h PO/IV q8h for 6 weeks
- Pediatric dose: Ampicillin-sulbactam 300 mg/kg/24h IV q46h; Gentamicin 3 mg/kg/24h IV/IM q8h; Vancomycin 40 mg/kg/24h IV q812h; Cefepime 150 mg/kg/24h IV q8h; Rifampin 20 mg/kg/24h PO/IV q8h
- Pathogen-directed antimicrobial therapy
- Bartonella
- Suspected Bartonella endocarditis
- Preferred regimen : Ceftriaxone sodium 2 g/24h IV/IM in 1 dose for 6 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 2 weeks  Doxycycline 200 mg/kg/24h IV/PO q12h for 6 weeks
- Pediatric dose: Ceftriaxone 100 mg/kg/24h IV/IM once daily; Gentamicin 3 mg/kg/24h IV/IM q8h; Doxycycline 24 mg/kg/24h IV/PO q12h; Rifampin 20 mg/kg/24h PO/IV q12h
- Documented Bartonella endocarditis
- Preferred regimen: Doxycycline 200 mg/24h IV or PO q12h for 6 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 2 weeks
- Pediatric dose: Ceftriaxone 100 mg/kg/24h IV/IM once daily; Gentamicin 3 mg/kg/24h IV/IM q8h; Doxycycline 24 mg/kg/24h IV/PO q12h; Rifampin 20 mg/kg/24h PO/IV q12h
- Enterococcus
- Endocarditis caused by enterococcal strains susceptible to penicillin, gentamicin, and vancomycin
- Preferred regimen : Ampicillin 12 g/24h IV q4h for 46 weeks OR Penicillin G 1830 million U/24h IV either continuously or q4h for 46 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 46weeks
- Alternative regimen : Vancomycin 30 mg/kg/24h IV q12h for 6 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 6 weeks
- Pediatric dose: Vancomycin 40 mg/kg/24h IV q812h; Gentamicin 3 mg/kg/24h IV/IM q8h
- Endocarditis caused by enterococcal strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin
- Preferred regimen : Ampicillin 12 g/24h IV q4h for 46 weeks OR Penicillin G 24 million U/24h IV continuously or q4h for 46 weeks AND Streptomycin 15 mg/kg/24h IV/IM q12h for 46 weeks
- Alternative regimen : Vancomycin 30 mg/kg/24h IV q12h for 6 weeks AND Streptomycin 15 mg/kg/24h IV/IM q12h for 6 weeks
- Pediatric dose: Ampicillin 300 mg/kg/24h IV q46h; Penicillin 300 000 U/kg/24h IV q46h; Streptomycin 2030 mg/kg/24h IV/IM q12h; Vancomycin 40 mg/kg/24h IV q812h; Streptomycin 2030 mg/kg/24h IV/IM q12h
- Endocarditis caused by enterococcal strains resistant to penicillin and susceptible to aminoglycoside and vancomycin
- -Lactamaseproducing strain
- Preferred regimen: Ampicillin-sulbactam 12 g/24h IV q6h for 6 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 6 weeks
- Alternative regimen : Vancomycin 30 mg/kg/24h IV q12h for 6 weeks
- Pediatric dose: Ampicillin-sulbactam 300 mg/kg/24h IV q6h; Gentamicin 3 mg/kg/24h IV/IM q8h
- Intrinsic penicillin resistance
- Preferred regimen: Vancomycin 30 mg/kg/24h IV q12h for 6 weeks AND Gentamicin 3 mg/kg/24h IV/IM q8h for 6 weeks
- Pediatric dose: Vancomycin 40 mg/kg/24h IV q812h; Gentamicin 3 mg/kg/24h IV/IM q8h
- Endocarditis caused by enterococcal strains resistant to penicillin, gentamicin, and vancomycin
- Enterococcus faecium
- Preferred regimen : Linezolid 1200 mg/24h IV/PO q12h for  8 weeks OR Quinupristin-Dalfopristin 22.5 mg/kg/24h IV q8h for 8 weeks
- Enterococcus faecalis
- Preferred regimen : Imipenem/cilastatin 2 g/24h IV q6h for  8 weeks AND Ampicillin 12 g/24h IV q4h for  8 weeks  OR Ceftriaxone sodium 4 g/24h IV/IM q12h for  8 weeks AND Ampicillin 12 g/24h IV q4h for  8 weeks
- Pediatric dose: Linezolid 30 mg/kg/24h IV/PO q8h; Quinupristin-Dalfopristin 22.5 mg/kg/24h IV q8h; Imipenem/cilastatin 60100 mg/kg/24h IV q6h; Ampicillin 300 mg/kg/24h IV q46h; Ceftriaxone 100 mg/kg/24h IV/IM q12h
- HACEK organisms
- Endocarditis caused by Haemophilus, Aggregatibacter (Actinobacillus), Cardiobacterium, Eikenella corrodens, or Kingella
- Preferred regimen : Ceftriaxone sodium 2 g/24h IV/IM in 1 dose for 4 weeks OR Ampicillin 12 g/24h IV q6h for 4 weeks OR Ciprofloxacin 1000 mg/24h PO or 800 mg/24h IV q12h for 4 weeks
- Pediatric dose: Ceftriaxone 100 mg/kg/24h IV/IM once daily; Ampicillin-sulbactam 300 mg/kg/24h IV divided into 4 or 6 equally divided doses; Ciprofloxacin 2030 mg/kg/24h IV/PO q12h
- Staphylococcus
- Native valve endocarditis caused by oxacillin-susceptible staphylococci
- Preferred regimen (1): Nafcillin or Oxacillin 12 g/24h IV q46h for 6 weeks  Gentamicin 3 mg/kg/24h IV/IM q812h for 35 days
- Preferred regimen (2): Cefazolin 6 g/24h IV q8h for 6 weeks  Gentamicin 3 mg/kg/24h IV/IM q812h for 35 days
- Pediatric dose: Nafcillin or Oxacillin 200 mg/kg/24h IV q46h; Gentamicin 3 mg/kg/24h IV/IM q8h; Cefazolin 100 mg/kg/24h IV q8h; Gentamicin 3 mg/kg/24h IV/IM q8h
- Native valve endocarditis caused by oxacillin-resistant staphylococci
- Preferred regimen: Vancomycin 30 mg/kg/24h IV q12h for 6 weeks
- Pediatric dose: Vancomycin 40 mg/kg/24h IV q812h
- Prosthetic valve endocarditis caused by oxacillin-susceptible staphylococci
- Preferred regimen: Nafcillin or Oxacillin 12 g/24h IV q4h for  6 weeks AND Rifampin 900 mg/24h IV/PO q8h for  6 weeks AND Gentamicin 3 mg/kg/24h IV/IM q812h for 2 weeks
- Pediatric dose: Nafcillin or Oxacillin 200 mg/kg/24h IV q46h; Rifampin 20 mg/kg/24h IV/PO q8h; Gentamicin 3 mg/kg/24h IV/IM q8h
- Prosthetic valve endocarditis caused by oxacillin-resistant staphylococci
- Preferred regimen: Vancomycin 30 mg/kg 24 h q12h for  6 weeks AND Rifampin 900 mg/24h IV/PO q8h for  6 weeks AND Gentamicin 3 mg/kg/24h IV/IM q812h for 2 weeks
- Pediatric dose: Vancomycin 40 mg/kg/24h IV q812h; Rifampin 20 mg/kg/24h IV/PO q8h (up to adult dose); Gentamicin 3 mg/kg/24h IV or IM q8h
- Viridans group streptococci and Streptococcus bovis
- Native valve endocarditis caused by highly penicillin-susceptible viridans group streptococci and Streptococcus bovis (MIC  0.12 g/mL)
- Preferred regimen: Penicillin G 1218 million U/24h IV either continuously or q46h for 4 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 4 weeks
- Alternative regimen (1): (Penicillin G 1218 million U/24h IV either continuously or q4h for 2 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 2 weeks) AND Gentamicin 3 mg/kg/24h IV/IM in 1 dose for 2 weeks
- Alternative regimen (2): Vancomycin 30 mg/kg/24h IV q12h not to exceed 2 g/24h for 4 weeks
- Pediatric dose: Penicillin G 200,000 U/kg/24h IV q46h; Ceftriaxone 100 mg/kg/24h IV/IM in 1 dose; Gentamicin 3 mg/kg/24h IV/IM in 1 dose or q8h; Vancomycin 40 mg/kg/24h IV q812h
- Native valve endocarditis caused by relatively penicillin-resistant viridans group streptococci and Streptococcus bovis (MIC > 0.12 to  0.5 g/mL)
- Preferred regimen (1): (Penicillin G 24 million U/24h IV either continuously or q46h for 4 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 4 weeks) AND Gentamicin 3 mg/kg/24h IV/IM in 1 dose for 2 weeks
- Preferred regimen (2): Vancomycin 30 mg/kg/24h IV q12h not to exceed 2 g/24h for 4 weeks
- Pediatric dose: Penicillin G 200,000 U/kg/24h IV q46h; Ceftriaxone 100 mg/kg/24h IV/IM in 1 dose; Gentamicin 3 mg/kg/24h IV/IM in 1 dose or q8h; Vancomycin 40 mg/kg/24h IV q812h
- Prosthetic valve endocarditis caused by highly penicillin-susceptible viridans group streptococci and Streptococcus bovis (MIC  0.12 g/mL)
- Preferred regimen (1): (Penicillin G 24 million U/24h IV either continuously or q46h for 6 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 6 weeks)  Gentamicin 3 mg/kg/24h IV/IM in 1 dose for 2 weeks
- Preferred regimen (2): Vancomycin 30 mg/kg/24h IV q12h not to exceed 2 g/24h for 6 weeks
- Pediatric dose: Penicillin G 200,000 U/kg/24h IV q46h; Ceftriaxone 100 mg/kg/24h IV/IM in 1 dose; Gentamicin 3 mg/kg/24h IV/IM in 1 dose or q8h; Vancomycin 40 mg/kg/24h IV q812h
- Prosthetic valve endocarditis caused by relatively penicillin-resistant viridans group streptococci and Streptococcus bovis (MIC > 0.12 g/mL)
- Preferred regimen (1): (Penicillin G 24 million U/24h IV either continuously or q46h for 6 weeks OR Ceftriaxone 2 g/24h IV/IM in 1 dose for 6 weeks) AND Gentamicin 3 mg/kg/24h IV/IM in 1 dose for 2 weeks
- Preferred regimen (2): Vancomycin 30 mg/kg/24h IV q12h not to exceed 2 g/24h for 6 weeks
- Pediatric dose: Penicillin G 200,000 U/kg/24h IV q46h; Ceftriaxone 100 mg/kg/24h IV/IM in 1 dose; Gentamicin 3 mg/kg/24h IV/IM in 1 dose or q8h; Vancomycin 40 mg/kg/24h IV q812h
- Intravascular catheter-related infections Return to Top
- Mediastinitis, acute Return to Top
- Mycotic aneurysm Return to Top
- Empiric antimicrobial therapy
- Preferred regimen: Vancomycin 2 g/day IV divided q6-12h targeting trough concentration of 15-20 g/mL for 6 weeks (for critically ill patient, start with a loading dose of 25 mg/kg followed by 15 mg/kg q12h) AND (Ceftriaxone 2 g IV q24h for 6 weeks OR Piperacillin-Tazobactam 3.375 g IV q6h for 6 weeks OR Ciprofloxacin 400 mg IV q12h for 6 weeks)
- Alternative regimen: Consider substituting Daptomycin for Vancomycin.  Consider Cefepime, Imipenem-Cilastatin, Meropenem, or Ertapenem for Gram-negative bacteria.
- Lyme carditis Return to Top
- Lyme carditis, adult
- Parenteral regimen
- Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (1421) days
- Alternative regimen: Cefotaxime 2 g IV q8h for 14 (1421) days OR Penicillin G 1824 million U/day IV q4h for 14 (1421) days
- Oral regimen
- Preferred regimen: Amoxicillin 500 mg tid for 14 (1421) days OR Doxycycline 100 mg bid for 14 (1421) days OR Cefuroxime 500 mg bid for 14 (1421) days
- Alternative regimen: Azithromycin 500 mg PO qd for 710 days OR Clarithromycin 500 mg PO bid for 1421 days (if the patient is not pregnant) OR Erythromycin 500 mg PO qid for 1421 days
- Lyme carditis, pediatric
- Parenteral regimen
- Preferred regimen: Ceftriaxone 5075 mg/kg IV q24h (maximum, 2 g) for 14 (1421) days
- Alternative regimen: Cefotaxime 150200 mg/kg/day IV q68h (maximum, 6 g per day) for 14 (1421) days OR Penicillin G 200,000400,000 U/kg/day IV q4h (not to exceed 1824 million U per day) for 14 (1421) days
- Oral regimen
- Preferred regimen: Amoxicillin 50 mg/kg/day PO tid (maximum, 500 mg per dose) for 14 (1421) days OR Doxycycline (for children aged  8 years) 4 mg/kg/day PO bid (maximum, 100 mg per dose) for 14 (1421) days OR Cefuroxime 30 mg/kg/day PO bid (maximum, 500 mg per dose) for 14 (1421) days
- Alternative regimen: Azithromycin 10 mg/kg/day (maximum of 500 mg per day) for 710 days OR Clarithromycin 7.5 mg/kg PO bid (maximum of 500 mg per dose) for 1421 days OR Erythromycin 12.5 mg/kg PO qid (maximum of 500 mg per dose) for 1421 days
- Myocarditis, viral Return to Top
- Pericarditis, bacterial Return to Top
- Bacterial pericarditis
- Empiric antimicrobial therapy
- Preferred regimen: Vancomycin 1 g IV q12h targeting trough levels of 1520 g/mL for 28 days AND Ciprofloxacin 400 mg IV q12h for 28 days
- Alternative regimen (1): Vancomycin 1 g IV q12h targeting trough levels of 1520 g/mL for 28 days AND Cefepime 2 g IV q12h for 28 days
- Alternative regimen (2): Vancomycin 1 g IV q12h targeting trough levels of 1520 g/mL for 1442 days AND Ceftriaxone 2 g IV q24h for 1442 days
- Specific considerations
- Purulent pericarditis with contiguous pneumonia
- Preferred regimen: Vancomycin 1 g IV q12h targeting trough levels of 1520 g/mL AND (Ceftriaxone 12 g IV q12h OR Cefotaxime 2 g IV q68h) AND (Ciprofloxacin 400 mg IV q12h OR Levofloxacin 500750 mg IV q24h)
- Purulent pericarditis with contiguous head and neck infection
- Preferred regimen: Imipenem 500 mg IV q68h OR Ampicillin-Sulbactam 3 g IV q6h
- Purulent pericarditis secondary to infective endocarditis
- Preferred regimen: Vancomycin 1520 mg/kg IV q812h targeting trough levels of 1520 g/mL AND Gentamicin 3 mg/kg/day IV q812h
- Purulent pericarditis after cardiac surgery, pediatric
- Preferred regimen: Vancomycin 15 mg/kg IV q6h targeting trough levels of 1520 g/mL AND (Ceftriaxone 100 mg/kg/day IV q1224h OR Cefotaxime 200300 mg/kg/day IV q68h) AND Gentamicin 67.5 mg/kg/day IV q8h
- Purulent pericarditis with genitourinary infection, pediatric
- Preferred regimen: Vancomycin 15 mg/kg IV q6h targeting trough levels of 1520 g/mL AND (Ceftriaxone 100 mg/kg/day IV q1224h OR Cefotaxime 200300 mg/kg/day IV q68h) AND Gentamicin 67.5 mg/kg/day IV q8h
- Purulent pericarditis in immunocompromised host, pediatric
- Preferred regimen: Vancomycin 15 mg/kg IV q6h targeting trough levels of 1520 g/mL AND (Ceftriaxone 100 mg/kg/day IV q1224h OR Cefotaxime 200300 mg/kg/day IV q68h) AND Gentamicin 67.5 mg/kg/day IV q8h
- Pathogen-directed antimicrobial therapy
- Anaerobes
- Preferred regimen: Clindamycin 600900 mg IV q8h for 1442 days OR Metronidazole 7.5 mg/kg IV q6h for 1442 days OR Ampicillin-Sulbactam 3 g IV q6h for 1442 days
- Gram-negative bacilli
- Preferred regimen: Ciprofloxacin 400 mg IV q12h for 1442 days OR Levofloxacin 500750 mg IV q24h for 1442 days OR Cefepime 2 g IV q12h for 1442 days
- Legionella pneumophila
- Preferred regimen: Ciprofloxacin 400 mg IV q12h for 1442 days OR Levofloxacin 500750 mg IV q24h for 1442 days OR Azithromycin 500 mg IV q24h for 1442 days
- Mycoplasma pneumoniae
- Preferred regimen: Doxycycline 100 mg IV q12h for 1442 days OR Azithromycin 500 mg IV q24h for 1442 days
- Neisseria meningitidis
- Preferred regimen: Penicillin G 524 MU/day IM/IV q46h for 1442 days OR Cefotaxime 2 g IV q68h for 1442 days OR Ceftriaxone 2 g IV q24h for 1442 days
- Staphylococcus aureus, methicillin-susceptible
- Preferred regimen: Nafcillin 12 g IV q4h for 1442 days OR Oxacillin 12 g IV q4h for 1442 days OR Cefazolin 12 g IV q48h for 1442 days OR Vancomycin 1 g IV q12h targeting trough levels of 1520 g/mL for 1442 days OR Clindamycin 600900 mg IV q8h for 1442 days
- Staphylococcus aureus, methicillin-resistant
- Preferred regimen: Vancomycin 1 g IV q12h targeting trough levels of 1520 g/mL for 1442 days OR Linezolid 600 mg IV q12h for 1442 days
- Streptococcus pneumoniae, penicillin-susceptible
- Preferred regimen: Penicillin G 524 MU/day IM/IV q46h for 1442 days OR Cefotaxime 2 g IV q68h for 1442 days OR Ciprofloxacin 400 mg IV q12h for 1442 days OR Levofloxacin 500750 mg IV q24h for 1442 days
- Streptococcus pneumoniae, penicillin-resistant
- Preferred regimen: Ciprofloxacin 400 mg IV q12h for 1442 days OR Levofloxacin 500750 mg IV q24h for 1442 days OR Vancomycin 1 g IV q12h targeting trough levels of 1520 g/mL for 1442 days
- Pericarditis, fungal Return to Top
- Pericarditis, tuberculous Return to Top
- Pericarditis, viral Return to Top
- Rheumatic fever, primary prophylaxis Return to Top
- Rheumatic fever, secondary prophylaxis Return to Top
- Septic pelvic vein thrombophlebitis Return to Top