ΛΟΙΜΩΔΗΣ ΕΝΔΟΚΑΡΔΙΤΙΔΑ

ΛΟΙΜΩΔΗΣ ΕΝΔΟΚΑΡΔΙΤΙΔΑ

, . 60 .

(2.5) > : 100% .

1. 2. ( ) 3. 4. 5. 6. 7. 8. , , HIV,

- / ( - Fallot- ,

- ( ) - ) 5%//

- 2/3 -> 50% ( ) - , - 2/3 S.aureus (---)

- = . -

- / = - : ()

( ,- ) - ( , S.epidermidis) . - . -

. - -

/ - . (/ ) , , (S. Aureus).

- 1. 1. ( 50%, 40%, 10%)

2. 2. (-- ) 1. 2.

(2-60%) ( Roth, Osler,, )

- / (S.aureus ,Streptococcus pneumoniae, Neisseria gonorrhoeae) , , , 2 .

( > 50 ) , , , , , - - - 2

-80% - - / 39.5 ( ) - (85%)

. : Roth , , , . - (50%) Osler ,

/ - . - ( /SLE, , ) Janeway- , , ,

-(60%) - (44%)- /,, - (30-40%) , / / - (30% ) . - , +.

- ( IVDU))- -, - -

- (,,,,. ) - (, , , , )

-, , - ( Candida, Chlamydia psittaci) . . 3 24

. 5% . : - - ( , , HACEK, Brucella, Chlamydia psittaci,Rickettsia Coxiella burnetti,, ,

, , Libman-Sacks) -

( ,

) (, ) () (>4%) +

: / S. aureus bacteremia . 1

DU)KE 1) . 2) 3) (2 )

4) 5) . 6) S bovis

2-4 BOVIS (Minimum Inhibitory Concentration 0.12 g/mL) 1. 4 week regimens: Aqueous crystalline penicillin G sodium 12-18 million U)/24 h IV either continuously in 4 or 6 equally divided doses , or Ceftriaxone sodium 2 g/24 h IV/IM in 1 dose

or Vancomycin hydrochloride 30 mg/kg per 24 h IV in 2 equally divided doses not to exceed 2 g/24 h unless concentrations in serum are inappropriately low 2. 2 weeks regimens: Either aqueous crystalline penicillin G sodium 12-18 million U)/24 h IV either continuously or in 6 equally divided doses or Ceftriaxone sodium 2 g/24 h IV/IM in 1 dose

+ Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 1 dose or in 2 to 3 equally divided dose BOVIS (Minimum Inhibitory Concentration >0.12 g/mL and <0.5 g/mL)* 1. Either aqueous crystalline penicillin G sodium 24 million U)/24 h IV either continuously or in 4 or 6 equally divided doses for 4 wks

+ Gentamycin sulfate 3 mg/kg per 24 h IV/IM in 1 dose or in 2 to 3 equally divided doses for 2 wks 2. Vancomycin hydrochloride 30 mg/kg per 24 h IV in 2 equally divided doses for 4 wks; not to exceed 2 g/24 h unless concentrations in serum are inappropriately low .

/ 4-6 1/ Aqueous crystalline penicillin G 10 million U)/24 hr IV either continuously or 6 equally divided doses 4-6 weeks or Cefazolin 6 g/24 h IV in 3 equally divided doses for 6 wks

2/ Nafcillin or oxacillin or dicloxacillin 2 g IV every 4 to 6 hours for 4-6wks + Gentamicin (optional) 1mg/kg IM or IV/8hr for 3-5 days 3/ Vancomycin 1 g IV every 12 h for 4-6 wks

/ , , 4-8 penicillin, gentamicin, and vancomycin Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 3 equally divided doses for

4-6 wks + Aqueous crystalline penicillin G sodium 18-30 million U)/24 h IV either continuously or in 6 equally divided doses for 4-6 wks* or Ampicillin sodium 12 g/24 h IV in 6 equally divided doses for 4-6 wks* or Vancomycin hydrochloride 30 mg/kg per 24 h IV in 2 equally divided doses for 6 wks; not to exceed 2 g/24 h unless concentrations in serum

are inappropriately low penicillin gentamicin, and vancomycin 1/ -Lactamase producing Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 3 equally divided doses for 6 wks +

Ampicillin-sulbactam 12 g/24 h IV in 4 equally divided doses for 6 wks or Vancomycin hydrochloride 30 mg/kg per 24 h IV in 2 equally divided doses for 6 wks; not to exceed 2 g/24 h unless concentrations in serum are inappropriately low 2/ ntrinsic penicillin resistance: Vancomycin 30 mg/kg per 24 h IV in 2 divided doses for 6 wks + Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 3 equally divided doses for 6 wks

penicillin, gentamicin, vancomycin - E. faecium: One of the following: Linezolid 1200 mg/24 h IV/PO in 2 equally divided doses for 8 wk or Quinupristin-dalfopristin 22.5 mg/kg per 24 h IV in 3 equally divided doses for 8 wks - E. faecalis: Imipenem/cilastatin 2 g/24 h IV in 4 equally divided doses for 8 wks

+ Ampicillin sodium 12 g/24 h IV in 6 equally divided doses for 8 wks or Ceftriaxone sodium 2 g/24 h IV/IM in 1 dose for 8 wks . 2

4-6 1. Ampicillin-sulbactam 12 g/24 h IV in 4 equally divided doses for 4-6 wks + Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 3 equally divided doses for

4-6 wks OR 2. Vancomycin 30 mg/kg per 24 h IV in 2 equally divided doses for 4-6 wks; not to exceed 2g/24 h unless concentrations in serum are inappropriately low + Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 3 equally divided doses for 4-6 wks

: 1. 2. 3. 4. , , , (7-10 ) +

5. (>20 mm) 2-4 (<60 ) :

(S.aureus, S.epidermidis), (- - ) (>60 , ) ,S.aureus, S.epidermidis / 40%.

: staphyloccoci + gentamicin+rifampin + >6 streptococci Penicillin G + Gentamycin 6+2

I

I : - / - / - - -

I : 6

I 30-60 1. - Amoxicillin 2gr - IV-IM Ampicillin 2gr or Cefazolin/Ceftriaxone 1gr 2. ( ) - Cephalexin 2gr OR - Clindamycin 600mg OR

- Azithromycin /Clarithromycin 500 mg - IV-IM Cefazolin /Ceftriaxone 1gr OR Clindamycin 600 mg (- ---- ) : 100% .

- . - 4% / 3-8 . -

(/ ) - Marfan - - - /)

- - - - - ( Swan-Ganz)

- - - /

HACEK Suggested regimens for therapy of nativevalve endocarditis due to HACEK* microorganism One of the following: Ceftriaxone 2 g/24 h IV/IM in 1 dose for 4 wks or Ampicillin-sulbactam 12 g/24 h IV in 4 equally divided doses for 4 wks or

Ciprofloxacin 1000 mg/24 h PO or 800 mg/24 h IV in 2 equally divided doses for 4 weeks

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