HACEK Group Infections Medication

Updated: Sep 27, 2018
  • Author: Zartash Zafar Khan, MD, FACP; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Medication Summary

Empiric therapy with ceftriaxone or ampicillin-sulbactam is the recommended approach. Fluoroquinolones can be used in the case of allergy or intolerance to the recommended regimen. Treatment duration is 4 weeks for native valve disease and 6 weeks for prosthetic valve disease.



Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Ceftriaxone (Rocephin)

Drug of choice for treatment of endocarditis due to HACEK organisms. Third-generation cephalosporin with broad-spectrum, gram-negative activity. Lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins. No adjustment necessary in persons with renal or hepatic impairment. Dose should be administered postdialysis if undergoing hemodialysis.

Ampicillin and sulbactam (Unasyn)

Drug combination of beta-lactamase inhibitor with ampicillin. Interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication orally.

Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.

Ciprofloxacin (Cipro)

Alternative to ceftriaxone when treating HACEK in patients who are unable to tolerate beta-lactam treatment. Inhibits bacterial DNA synthesis and, consequently, growth.