Treatment of Infections Caused by HACEK Group Organisms

Treatment of Infections Caused by HACEK Group Organisms

Organisms	Preferred Therapy	Alternative Agents	Comments
Haemophilus spp. Aggregatibacter actinomycetemcomitans, A. aphrophilus, A. paraphrophilus, other species Cardiobacterium hominis Eikenella corrodens Kingella kingae	Ceftriaxone (2 g/d)	Ampicillin/sulbactam (3 g of ampicillin q6h) Levofloxacin (500-750 mg/d) Penicillin (16-18 million units q4h) or ampicillin (2 g q4h)	Ampicillin/sulbactam resistance has been described in Haemophilus and Aggregatibacter spp. Data on use of levofloxacin for endocarditis therapy are limited. Fluoroquinolones are not recommended for treatment of pts <18 years of age. Penicillin or ampicillin can be used if the organism is susceptible. However, because of the slow growth of HACEK bacteria, antimicrobial testing may be difficult, and β-lactamase production may not be detected.

Organisms

Preferred Therapy

Alternative Agents

Comments

Haemophilus spp.

Aggregatibacter actinomycetemcomitans, A. aphrophilus, A. paraphrophilus, other species

Cardiobacterium hominis

Eikenella corrodens

Kingella kingae

Ceftriaxone (2 g/d)

Ampicillin/sulbactam (3 g of ampicillin q6h)

Levofloxacin (500-750 mg/d)

Penicillin (16-18 million units q4h) or ampicillin (2 g q4h)

Ampicillin/sulbactam resistance has been described in Haemophilus and Aggregatibacter spp.

Data on use of levofloxacin for endocarditis therapy are limited. Fluoroquinolones are not recommended for treatment of pts <18 years of age.

Penicillin or ampicillin can be used if the organism is susceptible. However, because of the slow growth of HACEK bacteria, antimicrobial testing may be difficult, and β-lactamase production may not be detected.

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Table 89-1