Treatment of Patients With Pseudomonas Endocarditis With High Dose Aminoglycoside and Carbenicillin Therapy

Mp, Reyes; Brown, W. J.; Am, Lerner

doi:10.1097/00005792-197801000-00004

Cited by 87 publications

(37 citation statements)

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“…167 On the basis of clinical experience, 154,156,157 however, the preferred regimen for IE caused by P aeruginosa is high-dose tobramycin (8 mg/kg per day IV or intramuscularly in once-daily doses) with maintenance of peak and trough concentrations of 15 to 20 g/mL and Յ2 g/mL, respectively, in combination with either an extended-spectrum penicillin (eg, ticarcillin, piperacillin, azlocillin) or ceftazidime or cefepime in full doses (Class IIa, Level of Evidence: B). The toxicity associated with this regimen is surprisingly low; combination treatment should be given for a minimum of 6 weeks.…”

Section: Pseudomonas Speciesmentioning

confidence: 99%

Infective Endocarditis

Baddour¹,

Wilson²,

Bayer³

et al. 2005

Circulation

1,277

436

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Background-Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness. Methods and Results-This work represents the third iteration of an infective endocarditis "treatment" document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen. Conclusions-The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management. (Circulation. 2005; 111:e394-e433.)

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Section: Pseudomonas Speciesmentioning

confidence: 99%

Infective Endocarditis

Baddour¹,

Wilson²,

Bayer³

et al. 2005

Circulation

1,277

436

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“…76,77 Isolated right-sided pseudomonal IE can generally be managed with antibiotic therapy, with or without valve surgery. 78 Large doses of an antipseudomonal penicillin (eg, piperacillin 18 g/d) combined with an aminoglycoside (eg, tobramycin 5 to 8 mg ⅐ kg Ϫ1 ⅐ d…”

Section: Pseudomonasmentioning

confidence: 99%

Diagnosis and Management of Infective Endocarditis and Its Complications

Bayer¹,

Bolger²,

Taubert³

et al. 1998

Circulation

654

407

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“…Fluoroquinolones are frequently used in the treatment of severe gram-negative infectious diseases, and ciprofloxacin and pefloxacin have proved effective against certain P. aeruginosa infections (10). However, clinical failures have occurred because of the development of resistance during therapy (22,23) and there has also been a worldwide emergence of P. aeruginosa strains resistant to multiple older antimicrobial agents. These events indicate a need for experimental animal studies with newer antipseudomonal regimens.…”

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confidence: 99%

Comparative efficacies of ciprofloxacin and pefloxacin alone or in combination with fosfomycin in experimental endocarditis induced by multidrug-susceptible and -resistant Pseudomonas aeruginosa

Xiong

Potel

Caillon

et al. 1995

Antimicrob Agents Chemother

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The in vivo efficacy of ciprofloxacin or pefloxacin alone or in combination with fosfomycin was evaluated in experimental aortic valve endocarditis induced in 133 rabbits by a multidrug-susceptible or multidrugresistant strain of Pseudomonas aeruginosa. Therapy was initiated early (12 h after infection), when bacterial counts in aortic valve vegetations were relatively low, or late (48 h after infection), when vegetations contained a larger inoculum. Antibiotics were administered as a continuous 24-h intravenous infusion. Mean steady-state levels of ciprofloxacin (64 mg/kg), pefloxacin (64 mg/kg), and fosfomycin (300 mg/kg) in serum were 2.5, 4.2, and 63.9 mg/liter, respectively. For the multidrug-susceptible strain, all regimens except pefloxacin alone significantly reduced the number of CFU per gram of vegetation versus controls, whether treatment was performed early or late. For the multidrug-resistant strain, none of the regimens showed differences from untreated controls, except ciprofloxacin-fosfomycin, which significantly reduced bacterial counts in vegetations compared with controls when therapy was begun early (4.1 ؎ 1.1 log 10 CFU/g of vegetation; P < 0.001 versus the control). These data suggest that combination of fosfomycin with ciprofloxacin or pefloxacin is more effective than ciprofloxacin or pefloxacin alone for the therapy of severe infections caused by multidrugsusceptible P. aeruginosa.Severe infections caused by Pseudomonas aeruginosa are a major problem in hospitalized patients who often fail to respond to medical therapy alone (2, 23). Fluoroquinolones are frequently used in the treatment of severe gram-negative infectious diseases, and ciprofloxacin and pefloxacin have proved effective against certain P. aeruginosa infections (10). However, clinical failures have occurred because of the development of resistance during therapy (22, 23) and there has also been a worldwide emergence of P. aeruginosa strains resistant to multiple older antimicrobial agents. These events indicate a need for experimental animal studies with newer antipseudomonal regimens. Antimicrobial combinations have been proposed as a means of increasing bactericidal activity in vivo, and some data suggest a possible synergy of fluoroquinolones with other antimicrobial agents (5,14,20). Moreover, fosfomycin, a drug with remarkable activity against P. aeruginosa, has shown a synergistic bactericidal effect in vitro against multidrug-resistant P. aeruginosa when combined with ciprofloxacin (12,20).The present study was designed to evaluate the efficacy of ciprofloxacin or pefloxacin alone versus association with fosfomycin. Experiments were conducted with a rabbit model of aortic valve endocarditis induced by a multidrug-susceptible or multidrug-resistant strain of P. aeruginosa. MATERIALS AND METHODSMicroorganisms. Two clinical strains of P. aeruginosa isolated from the blood of burn unit patients with septicemia were found to be susceptible (PA1) or resistant (PA2) to multiple antibiotics. Both proved resistant to rabbit s...

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Treatment of Patients With Pseudomonas Endocarditis With High Dose Aminoglycoside and Carbenicillin Therapy

Cited by 87 publications

References 0 publications

Infective Endocarditis

Infective Endocarditis

Diagnosis and Management of Infective Endocarditis and Its Complications

Comparative efficacies of ciprofloxacin and pefloxacin alone or in combination with fosfomycin in experimental endocarditis induced by multidrug-susceptible and -resistant Pseudomonas aeruginosa

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