Medication Summary
Even though the main mode of treatment is surgical, patients with myocardial abscess still require antibiotics and adjunct agents for stabilization of hemodynamic status.
Antibiotics
Class Summary
These agents are used to treat susceptible organisms, especially Staphylococcus species, which are the most common organisms in myocardial abscesses.
Vancomycin (Lyphocin, Vancoled, Vancocin)
Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Useful in treatment of septicemia and skin structure infections. Indicated for patients who cannot receive or have not responded to penicillins and cephalosporins or those who have infections with resistant staphylococci. For abdominal penetrating injuries, combine with an agent active against enteric flora and/or anaerobes. Current recommendations are to target an AUC/MIC ratio of 400 to 600 to optomize vancomycin use between maximal clinical efficacy and minimal nephrotoxicity risk. [20] Used in conjunction with gentamicin for prophylaxis in patients allergic to penicillin who are undergoing GI or GU procedures.
Oxazolidinones
Linezolid
Used for MRSA infections
Lipoglycopeptide
Daptomycin
Used for MRSA
Penicillins
Nafcillin
Used for MSSA infections
Anticoagulants
Class Summary
Antithrombin and anticoagulant agents may be needed for prevention of DVT. Anticoagulants are required for stroke prevention after replacement of cardiac valves with mechanical prostheses.
Heparin
Augments activity of antithrombin III and prevents conversion of fibrinogen to fibrin. Does not actively lyse but is able to inhibit further thrombogenesis. Prevents reaccumulation of clot after spontaneous fibrinolysis.
Warfarin (Coumadin)
Interferes with hepatic synthesis of vitamin K – dependent coagulation factors. Used for prophylaxis and treatment of DVT, PE, and thromboembolic disorders. Tailor dose to maintain INR in range of 2-3.
Vasopressors
Class Summary
These agents are used to raise blood pressure and improve tissue perfusion in patients with septic shock or hypotension.
Dopamine (Intropin)
Stimulates both adrenergic and dopaminergic receptors. Hemodynamic effect dependent on dose. Lower doses predominantly stimulate dopaminergic receptors, which, in turn, produce renal and mesenteric vasodilation. Cardiac stimulation and renal vasodilation produced by higher doses.
After initiating therapy, increase dose by 1-4 mcg/kg/min q10-30min until optimal response is obtained. More than 50% of patients are maintained satisfactorily on doses < 20 mcg/kg/min.
-
Myocardial abscess. Transesophageal echocardiogram exhibiting aortic valvular endocarditis and aortic root abscess.
-
Myocardial abscess. Complete heart block seen on a 12-lead electrocardiogram in a patient with myocardial abscess involving the prosthetic aortic valve ring.
-
Myocardial abscess. Color Doppler imaging showing flow into the aortic root abscess.
-
Myocardial abscess. Aortic valvular ring abscess seen by transesophageal echocardiography.
-
Myocardial abscess (gross).
-
Myocardial abscess (opened).
