The AHA Guidelines and Scientific Statements Handbook

The AHA Guidelines and Scientifi c Statements Handbook

Prosthetic valve (late, > 1 y)
6 IIibC Same regimens as listed
above for native valve
endocarditis with the addition
of rifampin.

Suspected Bartonella, culture negative
Ceftriaxone sodium
plus
gentamicin sulfate
with/without

doxycycline

2 g/24 h IV/IM in 1 dose 6 IIaB Patients with Bartonella

endocarditis should be

treated in consultation with

an infectious diseases

specialist.

3 mg/kg per 24 h IV/IM in 3 equally divided

doses

2

200 mg/24 h IV/PO in 2 equally divided

doses

6

Documented Bartonella, culture positive
Doxycycline
plus

gentamicin sulfate

200 mg/24 h IV or PO in 2 equally divided

doses

6 IIaB If gentamicin cannot be

given, then replace it with

rifampin, 600 mg/24 h PO/IV

3 mg/kg per 24 h IV/IM in 3 equally divided in 2 equally divided doses.

doses

Pediatric dose: Ceftriaxone 100 mg/kg per

24 h IV/IM once daily; gentamicin 3 mg/kg

per 24 h IV/IM in 3 equally divided doses;

doxycycline 2–4 mg/kg per 24 h IV/PO in 2

equally divided doses; rifampin 20 mg/kg per

24 h PO/IV in 2 equally divided doses

2

• Dosages recommended are for patients with normal renal function.
  ** Pediatric dose should not exceed that of a normal adult.
  † See text and Table 19.4 for appropriate dosing of gentamicin.
  ‡ See Table 19.4 for appropriate dosing of vancomycin.

IM indicates intramuscular, and PO, oral.

Table 19.14 Continued

Regimen Dosage and route

Duration

(weeks)

Strength of

recommendation Comments

including the lungs, coronary arteries, spleen, bowel,
and extremities. Up to 65% of embolic events
involve the central nervous system, and >90% of
central nervous system emboli lodge in the distribu-
tion of the middle cerebral artery. The highest inci-
dence of embolic complications is seen with aortic
and mitral valve infections and in IE caused by S.
aureus, Candida, HACEK, and Abiotrophia organ-
isms. Emboli can occur before diagnosis, during

therapy, or after therapy is completed, although

most emboli occur within the fi rst 2 to 4 weeks of

antimicrobial therapy.

Periannular extension of infection

Extension of IE beyond the valve annulus predicts

a higher mortality rate, more frequent develop-

ment of CHF, and more frequent cardiac surgery.