In empiric therapy treatment of infective endocarditis(beta lactam combination regimen)
if pt is sensetive to ceftriaxone can i use cefepime instead in addition to unictam
When there is an allergy from one beta lactam, it’s generally preferred to use a beta-lactam-free regimen to avoid cross hypersensitivity.
Hence you are talking empirical, you may consider using Vancomycin + Gentamicin, for example, if the patient is native valve. However, this my be too much for the kidneys.
European Society of Cardiology (ESC) 2023 guideline recommendations on empiric treatment in patients with infective endocarditis:
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For patients with community-acquired native valve or late prosthetic valve (≥ 12 months post-surgery), consider ampicillin plus ceftriaxone or ampicillin plus (flu)cloxacillin and gentamicin.(ESC Grade IIa, Level C).
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For patients with early prosthetic valve endocarditis (< 12 months after surgery) or with a nosocomial and non-nosocomial healthcare-associated infection, consider gentamicin and rifampin plus either vancomycin or daptomycin (ESC Grade IIb, Level C).
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For patients with an allergy to beta-lactams and community-acquired native valve or late prosthetic valve (≥ 12 months post-surgery), consider cefazolin or vancomycin plus gentamicin (ESC Grade IIb, Level C).
What can i give empirically if there’s shortage in vancomycin? And linezolid can’t be prescribed in our facility without culture (culture results appear in 10 days)‽