In the AHA Scientific Statement, “Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association,” by Baddour et al (Circulation. 2005;111:e394–e434), the following corrections/clarifications should be made:
There were two errors in Table 12 on page e413. In the “Ceftriaxone sodium” row, the entry in the “Dosage and Route” column originally read “2 g/24 h IV/IM in 1 dose” but should have read “4 g/24 h IV/IM in 2 equally divided doses.” In the “Pediatric dose” entry in the “Dosage and Route” column, the entry originally gave the dosage of ceftriaxone as “100 mg/kg per 24 h IV/IM once daily” but should have read “100 mg/kg per 24 h IV/IM in 2 equally divided doses.”
Although an every-24-hour dosing of ceftriaxone has never been formally studied in human trials in combination with ampicillin for the treatment of multidrug-resistant Enterococcus faecalis, unpublished animal model data indicate that every-12-hour dosing of ceftriaxone in combination with ampicillin is more efficacious in reducing the bacterial concentration in infected vegetations as compared with every-24-hour dosing of ceftriaxone with ampicillin. Therefore, the recommendation was changed to 2 equally divided doses per 24 hours.
In Table 14, for the section “Prosthetic valve (late, >1 y),” the Comments section should read: “Same regimens as listed above for native valve endocarditis with the addition of rifampin.”
In Tables 9 and 10, the following sentence should be deleted from the footnotes: “Patients with creatinine clearance of <50 mL/min should be treated in consultation with an infectious diseases specialist.” In Tables 11 and 14, the following portion of the first footnote should be deleted: “…see Table 9 for patients with creatinine clearance of <50 mL/min.”
In the third footnote of Table 7 and the second footnote of Table 8 (“Gentamicin should be…”), a second sentence should be added, which reads: “See Table 4 for appropriate dosage of gentamicin.” In Table 9, the second footnote should also refer the reader to Table 4 for appropriate dosage of gentamicin.
Although it is preferred that gentamicin (3 mg/kg) be given as a single daily dose to adult patients with endocarditis due to viridans group streptococci, as a second option, gentamicin can be administered daily in 3 equally divided doses (see Tables 4 through 6).
Table 4, titled “Therapy of Native Valve Endocarditis Caused by Highly Penicillin-Susceptible Viridans Group Streptococci and Streptococcus bovis,” lists reference No. 280 that refers to a nomogram for dosing gentamicin. Although this reference outlines dosing for gentamicin use at 7 mg/kg/dose for treatment in other types of infection syndromes, the nomogram was selected as an example for use with gentamicin dosing of 3 mg/kg/dose in this table to direct dosing in patients with underlying renal dysfunction. Currently, there is no other formal address of drug concentration monitoring with this gentamicin dosage.
On page e403, in the section on “Abiotrophia defectiva and Granulicatella Species, Gemella Species, and Viridans Group Streptococci With Penicillin MIC >0.5 μg/mL,” the following should be added as the last sentence of the section: “When vancomycin is the chosen antibiotic, the addition of gentamicin is not necessary.”