India Antibiotic Guideline for Cardiovascular Infections
In 2016 National Centre For Disease Control, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India came out with National Treatment Guidelines for Antimicrobial Use in Infectious Diseases.
Following are major recommendation
Cardiovascular Infections:
| Condition | Likely causative Organism | Empiric antibiotics (presumptive antibiotics) | Alternative antibiotics | Comments |
| Infective Endocarditis: Native valve (awaiting cultures) Indolent | Viridans Streptococci, other Streptococci, Enterococci | Penicillin G 20MU IV divided doses, 4 hourly or Ampicillin 2gm iv 4h AND Gentamicin 1mg/kg im or iv 8h Duration: 4-6 weeks | Vancomycin 15mg/kg IV 12 hourly (maximum 1g 12 hourly)//teicplani n 12mg/kg IV 12 hourly x 3 doses followed by 6 - 12 mg once daily IV depending upon severity + Gentamicin 1mg/kg IM or IV 8 hourly Duration: 4-6 weeks or Daptomycin 6mg/kg IV once a day Duration: 4-6 weeks | If patient is stable, ideally waitblood cultures. Antibiotic choice as per sensitivity results. Guidance from Infectious disease specialist or clinical microbiologist is recommended |
| Infective Endocarditis: Native valve (awaiting cultures) In Severe Sepsis | S.aureus (MSSA or MRSA) Risk for gramnegative bacilli | Vancomycin 25- 30 mg/kg loading followed by 15-20 mg/kg IV 12 hourly (maximum 1gm 12 hourly)/teicoplan in 12mg/kg IV 12 hourly x 3 doses followed by 6 -12 mg once daily IV depending upon severity AND Meropenem 1gm IV 8h Duration: 4-6 weeks | Daptomycin 6mg/kg IV once a day AND Meropenem 1gm IV q8h Duration: 4-6 weeks | Modify antibiotics based on culture results and complete 4-6 weeks of antibiotics |
| Infective Endocarditis: Prosthetic Valve awaiting Cultures | Vancomycin 15mg/kg IV 12 hourly (maximum 1gm 12 hourly)/teicoplan in 12mg/kg IV 12 hourly x 3 doses followed by 6 -12 mg once daily IV depending upon severity + Gentamicin 1mg/kg q12h IV | Daptomycin can be used in place of Vancomycin/ Teicoplanin for patients unresponsive to or intolerant of Vancomycin/Tei coplanin or with Vancomycin/Gly copeptideresistant isolates | Antibiotic choice as per sensitivity. Guidance from Infectious disease specialist or microbiologist is recommended. |
You can read the full Guideline by clicking on the following link :
http://www.ncdc.gov.in/writereaddata/linkimages/AMR_guideline7001495889.pdf
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