Moffitt BONUS PEARLS: Enterococcal endocarditis, Lyme disease

Enterococcal endocarditis

  • More difficult to cure, also significant drug resistance.
  • Need DUAL abx! Use ampicillin + ceftriaxone for synergy (in the past, often amp + gent, but now often use CTX b/c of toxicities a/w gent, and studies show CTX works just as well) x6 weeks
    • MOA: CTX saturates the beta-lactam receptors on bacterial cell walls, allowing for more ampicillin killing of the bacteria. So cool!

Lyme disease

  • Ixodes tick bite on for >24 hours!!
  • Clinical manifestations/treatment: 3 phases
    • 1) early localized (erythema migrans) à can treat with po doxycycline (10-21 days)
    • 2) early disseminated (acute neuro or cardiac involvement weeks to months after tick bite) à generally, IV ceftriaxone for 28 days
    • 3) late (arthritis, encephalopathy, polyneuropathy, years after) à IV CTX, cefotaxime, or PCN G for 28 days if CNS involvement
  • When to get serologies: Two-tier testing with ELISA followed by Western blot for Borrelia burgdorferi
    • +endemic area/exposure to ticks, +compatible sxs
    • NO serologies if:
      • erythema migrans rash – may be too early and serologies may be negative
      • Screening of asx pts, non-specific sxs (fatigue, myalgias/arthralgias) – low pre-test probability and high false positive rate!



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