Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Because of problems of penicillin allergy or lack of veins for intravenous administration of antibiotics, nine patients with endocarditis were treated with clindamycin, administered intramuscularly. Five patients were heroin addicts with staphylococcal endocarditis and four had alpha-streptococcal endocarditis. The only therapeutic failure occurred in a patient with a strain of Staphylococcus aureus that became resistant to clindamycin in vivo. Such resistance has been reported to occur in vitro, and testing for it should prove useful in proper selection of cases for treatment with clindamycin, an agent that appears to be effective in selected cases of endocarditis.
 ...
PMID:Clindamycin in infective endocarditis. 56 32

A 25-year-old black female heroin addict presented with Staphylococcus aureus endocarditis. Because of a history of penicillin allergy, therapy was gegun with cephalothin (Keflin); lack of clinical response led to the use of clindamycin. Response was excellent. After six weeks of treatment she was discharged well, only to return six days later with recurrent endocarditis. The organism, confirmed by sensitivity and phage typing, was identifcal to that causing the inital episode. This patient illustrates the apparent failure of clindamycin to eradicate a deep-seated intravascular infection with a sensitive organism.
 ...
PMID:Relapse of staphylococcal endocarditis after clindamycin therapy. 113 Apr 33

Bacterial endocarditis is a serious condition with high lethality. The authors review the etiology of the disease and conditions and procedures associated with increased risk, and give recommendations on choice and dosage of effective antibiotics. Most cases of endocarditis are caused by gram-positive cocci of the genera Streptococcus, Enterococcus or Staphylococcus. The number of cases caused by staphylococci has increased in recent decades. Risk of acquiring endocarditis is higher, for example, in patients with prosthetic cardiac valves and in patients with a previous history of endocarditis. Interventions associated with increased risk include various procedures in the mouth, throat and upper airways, since this is where the bacteria most often causing endocarditis are to be found. A single oral dose of amoxycillin is recommended for standard prophylaxis, and ampicillin in combination with an aminoglycoside for parenteral use. In cases of penicillin allergy, a single oral dose of clindamycin is recommended in patients at risk of bacteriemia from the respiratory tract, with trimetoprim as an alternative for genito-urinary and gastrointestinal procedures. Vancomycin or vancomycin plus aminoglycoside is recommended as a parenteral regimen in cases of penicillin allergy.
 ...
PMID:[Antibiotic prevention of bacterial endocarditis]. 155 92

Medical status of 1,500 patients attending a primary health care dental practice was examined by means of patient self-completed health questionnaire and by structured verbal interview by a dentist. Relevant medical histories and/or drug therapies affecting the practices of dentistry were found in 27.7% of patients. Problems identified included cardiovascular disease (10.4%), endocarditis risks (5.8%), hepatitis (7.9%), leukaemias (0.3%), bleeding tendencies (3%), drug allergies (7.0%), including penicillin allergy (3.6%) and intake of drugs affecting dentistry (6.0%). For most of these categories there was a marked increase in prevalence with increasing age and many categories contained many more women than could be expected from the male/female distribution of the total patient group.
 ...
PMID:Medical status of patients attending a primary care dental practice in Ireland. 181 12

Skin testing for penicillin allergy is an imperfect predictor of severe allergic reactions. We used decision analysis to identify the types of allergy history for which skin testing should alter management. The treatment threshold, the probability of a serious allergic reaction at which point one should switch from penicillin to another antibiotic, depends on the quality of life associated with the clinical outcomes. We measured 12 physicians' attitudes toward the outcomes of treatment with penicillin or vancomycin for Streptococcus viridans endocarditis in patients with a history of penicillin allergy. The clinicians' threshold probabilities ranged from .00010 to .00210 (median, .00013). Given the sensitivity (89% to 96%) and specificity (89% to 96%) of skin testing and our clinicians' median threshold, test results could alter the choice of antibiotic when the probability of a severe allergic reaction is between .00001 and .001. This range corresponds to a weak history of penicillin allergy. Although the decision should be individualized, our study suggests that skin testing is unnecessary when the patient has a convincing history of a severe allergic reaction to penicillin.
 ...
PMID:The role of skin testing for penicillin allergy. 145 64

Penicillin allergy presents a major obstacle to the successful management of some antepartum infections. We studied 15 pregnant women with histories of penicillin allergy confirmed by positive immediate wheal-and-flare skin tests. Thirteen had syphilis, one listeria sepsis, and one Streptococcus viridans endocarditis. Each patient was desensitized over four to six hours by oral administration of increasing doses of penicillin V. At the completion of the procedure, full-dose parenteral therapy with penicillin G or ampicillin was instituted. No extracutaneous reactions were detected. Five of the subjects (33 per cent) experienced pruritus (three) or urticaria (two), but no interruption of desensitization or therapy was necessary. All clinically apparent maternal infections were cured. The pregnancy complicated by listeriosis aborted in the first trimester. The 11 neonates delivered to date are normal. These results indicate that oral desensitization is an acceptably safe approach to therapy in pregnant women who are allergic to penicillin and have infections that require beta-lactam drugs.
 ...
PMID:Penicillin allergy and desensitization in serious infections during pregnancy. 392 35

Analysis of our data indicates confusion about, and lack of compliance with, the AHA recommendations. Clinician level of knowledge varies with issues of risk management and by specialty group membership. Patient groups that are particularly problematic include children and all patients with congenital heart disease, those receiving a continuing antibiotic regimen for secondary prevention of rheumatic fever, those with a penicillin allergy, and those with prosthetic heart valves. Another area of clinician uncertainty concerns dental procedures which may or may not be associated with the possible causation of bacterial endocarditis. The biodynamic principles involved in endocarditis are central to the structure of the AHA recommendations. These principles, as well as those which provide theoretical support for the loading dose, timing, sequence, and duration recommended by the AHA, have been presented with the hope that clinician compliance with these recommendations will be increased.
 ...
PMID:Clinician compliance and the prevention of bacterial endocarditis. 659 29

In a general survey it is stated that for single Staphylococcus aureus infections, clindamycin is not considered to be a first-line drug. Its chief indication is penicillin allergy. Penetration and accumulation of clindamycin within leukocytes demonstrated in vitro may be of value in the treatment of S. aureus diseases resulting in large abscesses. An insidious risk of the development of Clostridium difficile diarrhoea limits the use of clindamycin in ambulatory long-term treatment of diabetic osteitis and chronic osteomyelitis. Such patients must therefore be carefully checked during clindamycin therapy. In staphylococcal endocarditis treated with clindamycin, relapses and development of resistance have been reported. Mixed staphylococcal and anaerobic infections in skin, subcutaneous tissue, the diabetic foot, bone and joints are primary indications for clindamycin. S. epidermidis infections, especially septicemia and endocarditis, are not suitable for clindamycin therapy due to a high rate of resistance.
 ...
PMID:Clindamycin as an anti-staphylococcal agent--indications and limitations. 659 22

The extent to which prescribed antimicrobial prophylaxis against bacterial endocarditis conformed with American Heart Association (AHA) guidelines was determined and the frequency of nonconformity with specific elements of the guidelines was evaluated. Patients with conditions defined by AHA as placing them at risk for developing endocarditis were identified through medical records for a four-year period at an 850-bed hospital. Data about the procedures they underwent and prophylaxis prescribed were compared with the AHA guidelines. Conformity with the guidelines was evaluated according to whether prophylaxis was recommended, optional, or unnecessary; nonconformity with specific elements of the guidelines (indication, choice of antimicrobial, dose, dosage interval, timing, and duration) was also evaluated. The following variables were evaluated for possible association with nonconformity to the guidelines: patient's age and sex, penicillin allergy, use of a consultant, and whether the procedure was the first performed in the patient after identification of the cardiac condition. Of the 131 cases analyzed, 29 (22%) involved prophylaxis that conformed with the AHA guidelines. Conformity with the guidelines was significantly lower when prophylaxis was recommended or optional than when it was unnecessary. Nonconformity was most common with the following elements: indication, choice of antimicrobial, and dose. Recommended prophylaxis was given more often in children than in adults and more often before first procedures than before subsequent procedures. More of the regimens prescribed for children exceeded the recommended duration than those prescribed for adults. Unnecessary prophylaxis was given more often when a consultant was involved than when no consultant was involved. In hospitalized patients, conformity with AHA guidelines for antimicrobial prophylaxis against endocarditis was low.
 ...
PMID:Conformity with guidelines for antimicrobial prophylaxis against bacterial endocarditis. 784 5

Although the overall incidence of infective endocarditis in the paediatric population is considered to be low, over the last 20 years a rising trend in infective endocarditis has been observed among children. This could be due to several reasons including the availability of improved diagnostic techniques, use of continuous central venous catheters and cardiac implants increasing the risk of infection, and the survival of a greater number of infants with congenital heart disease as a result of improved medical management. The predominant causative organisms of paediatric endocarditis include staphylococci and streptococci. There is increased concern surrounding the emergence of endocarditis in children caused by methicillin-resistant Staphylococcus aureus and drug resistant strains of Streptococcus pneumoniae. The treatment approach to paediatric endocarditis is similar to that for adult patients with endocarditis because of similarities in disease pathogenesis and aetiology. The therapeutic goal is to achieve sterilisation of the cardiac vegetations. The choice of antibacterial is dependent upon the susceptibility profile of the causative organism. Vancomycin or gentamicin is recommended for enterococcal endocarditis, according to guidelines from the American Heart Association. For staphylococcal endocarditis in patients with no prosthetic valve, oxacillin or nafcillin with or without gentamicin is the treatment of choice. In the case of endocarditis caused by methicillin-resistant S. aureus, vancomycin is commonly used in patients with no prosthetic valve and a combination of vancomycin, gentamicin and rifampicin (rifampin) for patients with prosthetic material. Cefazolin or ceftriaxone is the treatment of choice for penicillin allergic paediatric patients with endocarditis caused by viridans streptococci. While there have been no major changes in endocarditis therapy for the last decade, the current focus is on the recognition of multiple-drug resistant pathogens and the use of newer agents such as quinupristin/dalfopristin in the treatment of resistant bacterial endocarditis. Prophylactic antibacterial therapy is recommended for procedures thought to be associated with the occurrence of bacteraemia involving organisms commonly associated with endocarditis. These include dental extractions and oral, respiratory tract, genitourinary, gastrointestinal or oesophageal procedures. Prophylactic antibacterials recommended by the American Heart Association during genitourinary and gastrointestinal surgical procedures in high risk patients include ampicillin + gentamicin or vancomycin + gentamicin in high risk patients with penicillin allergy. Ampicillin has been recommended for prophylaxis of bacterial endocarditis in children undergoing oral, respiratory tract or oesophageal procedures. In the case of penicillin allergy in these patients, cephalosporins, clindamycin, azithromycin or clarithromycin have been recommended. The general consensus is that antibacterial prophylaxis during dental procedure is unnecessary, and in fact propagates bacterial resistance.
 ...
PMID:Antibacterials for the prophylaxis and treatment of bacterial endocarditis in children. 1170 22


1 2 Next >>