Empiric Antibiotics for Infective Endocarditis? - USMLE Forums
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  #1  
Old 04-08-2012
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Drug Empiric Antibiotics for Infective Endocarditis?

A 55-year-old man presents to the emergency department with a 2-week history of fevers, chills, weakness, and shortness of breath. He was previously well and does not take any regular medications. On arrival, his blood pressure, is 130/70 mm Hg; pulse, 110 beats/min; temperature 39.3C (102.7F); and respirations, 32 breaths/min. Linear, red streaks are seen under the fingernails and are most prominent in the proximal nail bed. There is a pansystolic murmur heard over the apex that was not noticed 6 months ago during his annual health maintenance examination. An echocardiogram is performed and reveals mitral valve vegetations. Blood cultures are drawn. While awaiting results from the blood cultures, what is the most appropriate antibiotic regimen?

A. Ceftriaxone
B. Nafcillin, penicillin, gentamicin
C. Nafcillin, vancomycin
D. Penicillin
E. Vancomycin, gentamicin, rifampin
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Old 04-08-2012
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C. Nafcillin , Vancomycin
cuz MCC is Staph aureus. Nafcillin first line drug . and Vancomycin for resistant strains MRSA
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Old 04-11-2012
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Answer is B. to cover staph (nafcillin) to cover strep (penicillin) and add to gentamycin
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Quote:
Originally Posted by um aala View Post
ans is B.to cover staph(nafcillin)to cover sterp(pencillin) in add to gentamycin
nafcillin covers strep!!
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Quote:
Originally Posted by shyangel18 View Post
nafcillin covers strep!!
no, nifacillin for staph.
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Old 04-12-2012
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vancomycin plus gentamycin
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Old 04-12-2012
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Quote:
Originally Posted by dr.mariahas83 View Post
vancomycin plus gentamycin
It's naf and genta
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Old 04-12-2012
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Quote:
Originally Posted by tyagee View Post
It's naf and genta
but how can one be sure that its not MRSA?
isn't it better to start van and gent, and then switch according to the c/s results??
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yup its naf and genta
naf covers both staph and strep! Genta is for gram -ve rods
give this while awaiting cultures. then treat accordingly
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Old 04-19-2014
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Quote:
Originally Posted by shyangel18 View Post
yup its naf and genta
naf covers both staph and strep! Genta is for gram -ve rods
give this while awaiting cultures. then treat accordingly
But the answer is Penicilin, Naf and Genta.

I have NEVER seen anyone give Penicilin for IE and i worked in a Infectious disorders ward..

check this out

http://emedicine.medscape.com/article/1976353-overview

I say all this answers are wrong or outdated.

If it were naf+genta alone i would agree. Vanco+genta too. Ceftriaxone+genta..maybe.
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Old 04-20-2014
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Quote:
Originally Posted by drivenby View Post
But the answer is Penicilin, Naf and Genta.

I have NEVER seen anyone give Penicilin for IE and i worked in a Infectious disorders ward..

check this out

http://emedicine.medscape.com/article/1976353-overview

I say all this answers are wrong or outdated.

If it were naf+genta alone i would agree. Vanco+genta too. Ceftriaxone+genta..maybe.

Were did you find this question? Do you have the explanation?
prophilaxis is usually vancomycin (to cover MRSA) + gentamicin to cover the rest, except anaerobes.
I don't understand why you should give Penicillin + Naf together, since naf has just a wider spectrum than Penicillin, right? In this regimen there is no coverage for MRSA....
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Old 04-21-2014
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Quote:
Originally Posted by vero View Post
Were did you find this question? Do you have the explanation?
prophilaxis is usually vancomycin (to cover MRSA) + gentamicin to cover the rest, except anaerobes.
I don't understand why you should give Penicillin + Naf together, since naf has just a wider spectrum than Penicillin, right? In this regimen there is no coverage for MRSA....
From the way its written i think its from an NBME. It's not my question though i just saw it at the bottom of your topic in the " related topic" thing
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Old 10-03-2014
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yeah the penicillin seems a bit superfluous to me
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Old 06-25-2015
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B Acceptable empiric therapy would be a combination of an antistaphylococcal drug such as nafcillin (or oxacillin), a streptococcal drug such as penicillin (or ampicillin), and gentamicin. You must alter therapy as soon as a specific microbiologic agent is known. Vancomycin and gentamicin are the standard empiric treatment of infective endocarditis.
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Old 06-29-2015
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Although I do agree with the explanation given for option B ... my query is why is E not the answer? Both Kaplan and MTB agree to treat it with vanco + genta until results come back. Rifampin is added to treat staph secondary to prosthetic valve. Don't you think this is better than under treating with naf, genta and penicillin?
Ref page 31 MTB step2 edition2
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Cardiology-, Infectious-Diseases, Internal-Medicine-, Step-2-Questions

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