Injection Drug Users (right-sided)
[Circulation 2022;146:00-00 doi: 10.1161/CIR.0000000000001090]
- Test for HIV, viral hepatitis, and STIs.
- Recommend addiction medicine consultation/substance use disorder care as associated with reduced readmissions, and counselling on safer injection practices.
- Tailor antibiotic therapy to C&S results. β-lactams superior to vancomycin so preferred if susceptible. If penicillin allergy reported, allergy should be confirmed by an allergist and desensitization considered.
Usual Pathogens
S. aureus/MRSA
Streptococcus spp
Enterococcus spp
Rare:
P. aeruginosa
Enterobacterales, especially Serratia
Yeast
Polymicrobial
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin | 15mg/kg IV q8-12h | Culture negative - see Blood Culture-Negative Endocarditis. Culture positive - see Recommended Therapy of Culture-Directed Infections. |
| +/- | ||
| [Ceftriaxone | 2g IV daily | |
| or | ||
| Gentamicin] | 1.5-2mg/kg IV q8h |