tailieunhanh - Chapter 118. Infective Endocarditis (Part 8)

Organism-Specific Therapies Streptococci To select the optimal therapy for streptococcal endocarditis, the minimum inhibitory concentration (MIC) of penicillin for the causative isolate must be determined (Table 118-4). The 2-week penicillin/gentamicin or ceftriaxone/gentamicin regimens should not be used to treat complicated native valve infection or prosthetic valve endocarditis. The regimen recommended for relatively penicillin-resistant streptococci is advocated for treatment of endocarditis caused by organisms of group B, C, or G. Endocarditis caused by nutritionally variant organisms (Granulicatella or Abiotrophia species) and Gemella morbillorum is treated with the regimen for moderately penicillinresistant streptococci, as is prosthetic valve endocarditis caused by these organisms or by. | Chapter 118. Infective Endocarditis Part 8 Organism-Specific Therapies Streptococci To select the optimal therapy for streptococcal endocarditis the minimum inhibitory concentration MIC of penicillin for the causative isolate must be determined Table 118-4 . The 2-week penicillin gentamicin or ceftriaxone gentamicin regimens should not be used to treat complicated native valve infection or prosthetic valve endocarditis. The regimen recommended for relatively penicillin-resistant streptococci is advocated for treatment of endocarditis caused by organisms of group B C or G. Endocarditis caused by nutritionally variant organisms Granulicatella or Abiotrophia species and Gemella morbillorum is treated with the regimen for moderately penicillin-resistant streptococci as is prosthetic valve endocarditis caused by these organisms or by streptococci with a penicillin MIC of pg mL Table 118-4 . Enterococci Enterococci are resistant to oxacillin nafcillin and the cephalosporins and are only inhibited not killed by penicillin ampicillin teicoplanin not available in the United States and vancomycin. To kill enterococci requires the synergistic interaction of a cell wall-active antibiotic penicillin ampicillin vancomycin or teicoplanin that is effective at achievable serum concentrations and an aminoglycoside gentamicin or streptomycin to which the isolate does not exhibit high-level resistance. An isolate s resistance to cell wall-active agents or its ability to replicate in the presence of gentamicin at 500 pg mL or streptomycin at 10002000 pg mL a phenomenon called high-level aminoglycoside resistance indicates that the ineffective antimicrobial agent cannot participate in the interaction to produce killing. High-level resistance to gentamicin predicts that tobramycin netilmicin amikacin and kanamycin also will be ineffective. In fact even when enterococci are not highly resistant to gentamicin it is difficult to predict the ability of these other aminoglycosides to .

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