Cardiology>>>>>Pharmacology
Question 54#

S. C. is a 59-year-old woman diagnosed with enterococcal endocarditis. She has no known drug allergies. Which of the following would exhibit standard therapy?

A. Penicillin G, 5 million units IV every 4 hours for 4 to 6 weeks, plus gentamicin, 2.5 mg/kg IV every 8 hours for 4 to 6 weeks
B. Ampicillin, 2 g IV every 4 hours for 4 to 6 weeks, plus gentamicin, 1 mg/kg IV every 8 hours for 4 to 6 weeks
C. Ampicillin, 2 g IV every 4 hours for 4 to 6 weeks, plus gentamicin, 1 mg/kg IV every 8 hours for 3 to 5 days
D. Vancomycin, 30 mg/kg per 24 hours in two equally divided doses for 4 to 6 weeks

Correct Answer is B

Comment:

b. Ampicillin, 2 g IV every 4 hours for 4 to 6 weeks, plus gentamicin, 1 mg/kg IV every 8 hours for 4 to 6 weeks. Treatment of enterococcal endocarditis is complicated because of the high levels of resistance to penicillin, extended-spectrum penicillins, and vancomycin. However, penicillin, ampicillin, or vancomycin in combination with an aminoglycoside causes synergistic bactericidal effect on these organisms. Treatment with an aminoglycoside for the full 4 to 6 weeks at a synergistic dose (1 mg/kg IV every 8 hours) in addition to the penicillin agent or vancomycin is required.