Aortitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Overview

Early antimicrobial therapy with broad spectrum coverage is indicated in infectious aortitis. The preferred agents include either cefotaxime, ciprofloxacin, penicillinase-resistant penicillins, or vancomycin. Surgical debridement is recommended among patients with gram-negative rod aortitis.

Medical Therapy

Infectious Aortitis

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

• 1. Gram-negative coverage

• Preferred regimen (1): Cefotaxime sodium 1-2 g IV q24h
• Preferred regimen (2): Ciprofloxacin 400 mg IV q12h OR Ciprofloxacin 500-750 mg PO q12h OR Levofloxacin 250-750 mg IV/PO q24h

• 2. Staphylococcal coverage

• 2.1 Methicillin-sensitive Staphylococcus aureus (MSSA)

• Preferred regimen: Oxacillin 1-2 g IV/IM q4-6h OR Nafcillin 1-2 g IV/IM q4-6h OR Dicloxacillin 0.5-1 g IV/IM q4-6h

• 2.2 Methicillin-resistant Staphylococcus aureus (MRSA)

• Preferred regimen: Vancomycin 1 g (15 mg/kg) IV q12h (maximum dose 3-4 g/day)

• Note: Dose of cefotaxime sodium should be decreased by 50% among patients with a creatinine clearance (CCr) of ≤ 20 mL/min. Ciprofloxacin should be used cautiously among patients with a CCr ≤ 50 mL/min or when given concomitantly with drugs whose metabolism may be altered.