Infectious Diseases in Critical Care Medicine

Table 22 Therapy of Various Types of Infective Endocarditisa

Organism Antibiotic regimen Alternative regimen

Culture-negative Ampicillin 2 g IV q4h for 4 wkb Culture-negative
and
Gentamicin 5 mg/kg q24h IV given in a
single dose or in divided doses q8h for
the first 2 wk
and
Oxacillin 2 g IV q4h for 4 weeks
or if
MRSA is suspected or prosthetic
material is present, vancomycin 30
mg/kg q12h for 4 wk
Pseudomonas aeruginosa Ticarcillin 3 g IV q4h for 6 wkb Ceftazidimec2 g IV q8h for 6 wk
and Or
Tobramycin 5 mg/kg q24h IV given in a
single dose or in divided doses q8h

Aztreonamd2 g IV q6h for 6 wk

And
Tobramycin 5 mg/kg IV q24h given
in a single dose or in divided
doses q8h
HACEK group Ampicillin 2 g IV q4h for 4-6 wkb Cefotaximec2 g IV q8h for 4–6 wk
and And
Gentamicin 5 mg/kg q24h as a single
dose or in divided doses q8h

Gentamicin 5 mg/kg q24h given in a

single dose or in divided doses

aFor patients with normal renal function.
bPreferred regimen (see text).
c1n patients with mild penicillin allergy.
d1n patients with severe penicillin allergy.

Source: From Ref. 222.

Table 23 Representative Antibiotic Therapy of Various Forms of Infective Endocarditisa,b

Organism Dosage regimen

Corynebacterium jeikium Vancomycin 1 g q12h IV
plus
Gentamicin 1 mg/kg q8h
Listeria monocytogenes Ampicillin 12 g/day
plus
Gentamicin 1.7 mg/kg q8h
Coxiella burnetii Doxycycline 100 mg IV/PO b.i.d.
plus
Chloroquine 200 mg t.i.d.^3
Brucellaspp. Doxycycline 100 mg b.i.d. PO
plus
Rifampin 900 mg/day PO
plus
Trimethoprim–/Sulfamethoxazole 160/800 mg PO t.i.d.
Bartonellaspp. Ceftriaxone 2 g/day for 6 wk, gentamicin 1 mg/kg q8h x14 days
plus
Doxycycline 100 mg IV x 6 wk

aFor patients with normal renal function.
bGiven for at least 6 wk.
cSee text for duration of therapy.

Source: From Ref. 222.

Infective Endocarditis and Its Mimics in Critical Care 247