Today we saw pictures of some of the signs of endocarditis such as osler’s nodes, janeway lesions, ruth spots and splinter hemorrhages. We also discussed two cases, one was an IVDU with a mitral valve prolapsed with regurgitation and the other was a patient with a mitral valve replacement. In 70% of IVDU the organism is staph, in this patient we started treating with vancomycin to cover for MRSA. When we were given the culture results the patient had MSSA so we changed therapy to cloxacillin 2g q4h for 2 weeks (right sided uncomplicated). The second patient had an MRSA from a prosthetic heart valve so we gave vancomycin and rifampin for 6 weeks but chose not to add gentamycin because of the patients chronic renal failure. In both cases the patients start date of their duration of treatment would be from the first culture negative day. Finally, we discussed the monitoring points for efficacy and safety while on vancomycin and rifampin.
Efficacy: Monitor Temp, RR, HR, BP q 4h until stable then q shift change, Malaise/lethargy, blood cultres/WBC/ neuts q 2days, skin rash/myalgia
