Treatment
•Pre-antibiotic era - a death sentence
•Antibiotic era
–microbiologic cure in majority of patients
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New Treatments
•Right-sided infective endocarditis due to methicillin-susceptible S aureus (MSSA) in IV drug users
–2-wk therapy with a penicillinase-resistant penicillin and an aminoglycoside
–2-wk monotherapy with IV cloxacillin
–short-term therapy is inappropriate if complicated by ostomyelitis, meningitis, myocardial abscess, or concomitant left-sided involvement
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New Treatments
•Highly penicillin-susceptible Streptococcus viridans or bovis
–Once-daily ceftriaxone for 4 wks
•cure rate > 98%
•easily administered as outpatient, avoid hospitalization, offers significant cost savings
–Once-daily ceftriaxone 2 g for 2wks followed by oral amoxicillin qid for 2 wks
–Once-daily ceftriazone and netilmicin for 2 wks
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New Treatments
•Prosthetic valve endocarditis due to fluconazole-susceptible Candida species
–many are due to bloodstream invasion
–chronic oral suppressive therapy with fluconazole for inoperable disease
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SBE Prophylaxis
Standard general prophylaxis |
amoxicillin |
Unable to take oral meds |
ampicillin |
Allergic to penicilin |
clindamycin |
|
cephalexin |
|
azithromycin |
|
clarithromycin |
Allergic to penicillin and unable |
clindamycin |
to take oral medications |
cefazolin |
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References
•Prevention of bacterial endocarditis. Recommended by the American Heart Association.
Dajani AS, Taubert KA, Wilson W, et al. Circulation 1997;96:358-366
•New Criteria for diagnosis of infective endocarditis: Utilization of specific echocardiographic findings.
Durack DT, Lukes AS, Bright DK, et al. Am J Med 1994;96:200-209
•Antibiotic treatment of adults with infective endocarditis due to strptococci, enterococci, staphlococci, and HACEK microorganisms. Wilson WR, Karchmer AW, Dajani AS. JAMA 1995;274:1706-1713
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