Mediastinitis medical therapy

Jump to navigation Jump to search

Mediastinitis Microchapters


Patient Information


Historical Perspective




Differentiating Mediastinitis from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray



Other Imaging Findings


Medical Therapy


Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Mediastinitis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides


American Roentgen Ray Society Images of Mediastinitis medical therapy

All Images
Echo & Ultrasound
CT Images

Ongoing Trials at Clinical

US National Guidelines Clearinghouse

NICE Guidance

FDA on Mediastinitis medical therapy

CDC on Mediastinitis medical therapy

Mediastinitis medical therapy in the news

Blogs on Mediastinitis medical therapy

Directions to Hospitals Treating Mediastinitis

Risk calculators and risk factors for Mediastinitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]


The mainstay of therapy in acute mediastinitis secondary to cardiothoracic surgery includes clindamycin and ceftriaxone. The preferred regimen for preoperative prophylaxis against acute mediastinitis includes either a second generation cephalosporin or vancomycin. Descending necrotizing mediastinitis is a very serious complication of oropharyngeal infections that should be treated promptly with early and aggressive surgical debridement and broad spectrum antibiotics that provide coverage against MRSA, beta-lactamase producing gram-negative organisms, and anaerobes.

Medical Therapy

Antimicrobial Regimens

  • 1. Post-cardiothoracic surgery mediastinitis[1]
  • 1.1 Treatment
  • Note: A deep sternal wound infection should be treated with aggressive surgical debridement in the absence of complicating circumstances.
  • 1.2 Prophylaxis
  • 1.2.1 Methicillin susceptible staphylococcus aureus
  • 1.2.2 Methicillin resistant staphylococcus aureus
  • Preferred regimen: Vancomycin 15 mg/kg IV single dose
  • Note (1): Preoperative antibiotics should be administered to all patients to reduce the risk of mediastinitis in cardiac surgery.
  • Note (2): The use of intranasal mupirocin is reasonable in nasal carriers of S. aureus.
  • 2. Descending necrotizing mediastinitis
  • Preferred regimen (1): Vancomycin 2 g/day IV q6-12h (trough levels 15-20 mg/L) AND Imipenem 500 mg IV q6h
  • Preferred regimen (2): Vancomycin 2 g/day IV q6-12h (trough levels 15-20 mg/L) AND Meropenem 1 g IV q8h
  • Preferred regimen (3): Vancomycin 2 g/day IV q6-12h (trough levels 15-20 mg/L) AND Piperacillin-Tazobactam 3.375 g IV q6h
  • Note: The mainstay of therapy for descending necrotizing mediastinitis is surgical debridement.


  1. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons". J Am Coll Cardiol. 58 (24): e123–210. doi:10.1016/j.jacc.2011.08.009. PMID 22070836.

Template:WikiDoc Sources