Infective Endocarditis

Laboratory investigations

Blood cultures

Management

Antibiotics

Native valve - Empirical therapy
Amoxicillin +/- synergistic gentamicin
Penicillin allergic: vancomycin + low-dose gentamicin

Native valve - with positive blood cultures
Staphylococcus aureus: Flucloxacillin
Penicillin allergic: Vancomycin + rifampicin
MRSA: vancomycin + rifampicin + synergistic gentamicin
Viridans streptococcus: benzylpenicillin

**Prosthetic valve **
Empirical therapy- vancomycin + rifampicin + low-dose gentamicin
MRSA: Vancomycin + rifampicin + low-dose gentamicin
Penicillin allergic: Vancomycin + rifampicin + low-dose +++

Surgery

Indications
severe valvular incompetence
aortic abscess (often indicated by a lengthening PR interval)
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy

Monitoring

Daily ECGs - monitor for PR interval prolongation (may indicate aortic root abscess)

Complications

Valvular incompetence
Cardiac failure
Emboli
Aortic root abscess

Prognosis

Mortality
staphylococci - 30%
bowel organisms - 15%
streptococci - 5%

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License