Aortitis medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
Suspected infectious aortitis should be promptly recognized and treated. Empiric antibiotic coverage is recommended for all patients pending culture results with agents providing adequate coverage for Staphylococcus spp. and gram-negative rods. Given the significant mortality associated with infectious aortitis treated with antibiotic therapy alone, particularly when gram-negative organisms are involved, surgical debridement With or without aneurysm repair is recommended (weak recommendation - data from case series not clinical trials). Treatment duration is 6 to 12 weeks following surgical debridement and clearance of blood cultures. | |||
* | ===Antimicrobial Regimen=== | ||
*'''Empiric Antimicrobial Therapy''' | |||
:* Preferred regimen(1): [[Cefotaxime sodium]] 1.0 to 2.0 g IV qd<ref name="pmid15935117">{{cite journal| author=Foote EA, Postier RG, Greenfield RA, Bronze MS| title=Infectious Aortitis. | journal=Curr Treat Options Cardiovasc Med | year= 2005 | volume= 7 | issue= 2 | pages= 89-97 | pmid=15935117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15935117 }} </ref> | :* Preferred regimen(1): [[Cefotaxime sodium]] 1.0 to 2.0 g IV qd<ref name="pmid15935117">{{cite journal| author=Foote EA, Postier RG, Greenfield RA, Bronze MS| title=Infectious Aortitis. | journal=Curr Treat Options Cardiovasc Med | year= 2005 | volume= 7 | issue= 2 | pages= 89-97 | pmid=15935117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15935117 }} </ref> | ||
:* Preferred regimen (2): [[Ciprofloxacin hydrochloride]] 400 mg IV q12h {{or}} [[Ciprofloxacin hydrochloride]] 500 to 750 mg PO q12h {{or}} [[Levofloxacin]] 250 to 750 mg IV/PO qd | :* Preferred regimen (2): [[Ciprofloxacin hydrochloride]] 400 mg IV q12h {{or}} [[Ciprofloxacin hydrochloride]] 500 to 750 mg PO q12h {{or}} [[Levofloxacin]] 250 to 750 mg IV/PO qd | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
Overview
Antimicrobial therapy is indicated in infectious aortitis. The preferred regimen includes either Cefotaxime, Ciprofloxacin, Penicillinase-resistant Penicillins, or Vancomycin.
Medical Therapy
Suspected infectious aortitis should be promptly recognized and treated. Empiric antibiotic coverage is recommended for all patients pending culture results with agents providing adequate coverage for Staphylococcus spp. and gram-negative rods. Given the significant mortality associated with infectious aortitis treated with antibiotic therapy alone, particularly when gram-negative organisms are involved, surgical debridement With or without aneurysm repair is recommended (weak recommendation - data from case series not clinical trials). Treatment duration is 6 to 12 weeks following surgical debridement and clearance of blood cultures.
Antimicrobial Regimen
- Empiric Antimicrobial Therapy
- Preferred regimen(1): Cefotaxime sodium 1.0 to 2.0 g IV qd[1]
- Preferred regimen (2): Ciprofloxacin hydrochloride 400 mg IV q12h OR Ciprofloxacin hydrochloride 500 to 750 mg PO q12h OR Levofloxacin 250 to 750 mg IV/PO qd
- Preferred regimen (3): Oxacillin 1.0 to 2.0g IV or IM q4h / q6h OR Nafcillin 1.0 to 2.0 g IV or IM q4h / q6h OR Dicloxacillin 500 mg to 1.0 g IV or IM q4h /q6h
- Preferred regimen (4): Vancomycin 1.0 g (15 mg/kg, up to 3.0 to 4.0 g/d) IV q12h
- Note: Antimicrobial treatments are most effective when bactericidal, broadspectrum antibiotics are begun after obtaining blood cultures and prior to surgery. Dose of Cefotaxime sodium should be decreased by 50% in those with a creatinine clearance (CCr) of ≤ 20 mL/min. Ciprofloxacin should be used cautiously in those with a CCr ≤ 50 mL/min or when given concomitantly with drugs whose metabolism may be altered.
References
- ↑ Foote EA, Postier RG, Greenfield RA, Bronze MS (2005). "Infectious Aortitis". Curr Treat Options Cardiovasc Med. 7 (2): 89–97. PMID 15935117.