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Re: Infective Endocarditis
No reported clinical trials have compared AG dosage
frequency in patients with infective endocarditis. Based on
in vitro studies and animal models of endocarditis, some
tentative generalizations are possible. The antibacterial
effect of aminoglycosides against enterococcus spp. requires
the continuous presence of both a cell wall-active B-lactam
antibiotic (eg ampicillin) and an aminoglycoside. Hence,
once daily dosing does not seem justified. Assuming in
vitro susceptibility and evidence of clinical response, the
current consensus reccommendation of an American heart
Asso-sponsored expert commitee is penicillin G plus
gentamicin, 3 mg/kg/day (assuming normal renal function)
divided into an every 8 hour dosage schedule, for viridans
streptococcal and enterococcal endocarditis.: (Basic
Principles in the diagnosis & management of infectious
diseases; pg 329).
PLEASE, be sure to inform these patients to tell you of any
peculiar dizziness, oscillopsia, or bobbing vision. Extended
use of gentamicin seems to be the culprit of ototoxicity.
Halmagyi; Nov 1994; Otolaryngol Head Neck Surg; Pg. 574:
Mild to Moderate gentamicin vestibulotoxicity is reversible;
therefore, if it is recognized early and the gentamicin is
stopped, vestibular function can recover, and permanent
vestibular ataxia can be prevented.
If it is at all possible, it would be helpful to have eng
testing done on these patients to assess the health of the
vestibular nerve prior to starting the gentamicin therapy.
C J Petersen
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