From the Guidelines
Endocarditis management requires prompt medical attention, typically involving hospitalization for intravenous antibiotics for 2-6 weeks, with specific regimens determined by the causative organism, as recommended by the American Heart Association 1 and the European Society of Cardiology 1.
Signs and Symptoms
The signs and symptoms of endocarditis include:
- Persistent fever
- Night sweats
- Fatigue
- Shortness of breath
- Chest pain
- Heart murmurs
- Janeway lesions (painless red spots on palms/soles)
- Osler's nodes (painful nodules on fingertips)
- Splinter hemorrhages under nails
- Petechiae
Treatment
The treatment of endocarditis typically involves:
- Combinations of penicillins (such as penicillin G 12-18 million units/day or ampicillin 12g/day) with gentamicin (3mg/kg/day)
- Vancomycin (15-20mg/kg every 12 hours) for resistant organisms
- Surgery may be necessary for complications like heart failure, uncontrolled infection, or large vegetations
- The duration of treatment is based on the first day of effective antibiotic therapy, not on the day of surgery, and should last for at least 4 to 6 weeks for native valve endocarditis and at least 6 weeks for prosthetic valve endocarditis 1.
Diagnosis and Prevention
Diagnosis involves:
- Blood cultures
- Echocardiography to visualize vegetations Prevention involves:
- Antibiotic prophylaxis before certain procedures for high-risk patients
- Prompt treatment of infections that could lead to bacteremia
- It is essential to consult with an infectious diseases specialist to define the most appropriate choice of therapy in patients with culture-negative endocarditis 1.
From the Research
Endocarditis Management and Treatment
- The management of infective endocarditis involves effective therapy, with at least 85% of patients being cured 2.
- Antibiotic treatment is the primary approach, with the type and duration of treatment depending on the causative organism 2, 3.
- For streptococcal endocarditis, treatment with aqueous penicillin G alone or in combination with streptomycin is recommended 2.
- For staphylococcal endocarditis, treatment with a semisynthetic penicillin or a cephalosporin is recommended 2, 3.
- The optimal duration of antibacterial treatment is 4 weeks for most native valve endocarditis and 6 weeks for prosthetic-valve endocarditis 3.
Signs and Symptoms
- The signs and symptoms of endocarditis are not explicitly stated in the provided studies, but the management and treatment approaches are discussed in detail 2, 3, 4.
- Complicated endocarditis requires treatment at a hospital with an endocarditis team and cardiac surgery 4.
Treatment Strategies
- Empirical treatment with a combination of antibiotics may be necessary before the causative organism is identified 2.
- The use of aminoglycosides has been dramatically reduced over the last 20 years, and should be administered once daily for no longer than 2 weeks 3.
- Oral switch is safe in patients stabilized after the initial intravenous course 3, 4.
- Step-down ambulatory (oral or parenteral) further antibiotic therapy is recommended for patients with left-sided endocarditis caused by certain organisms who are stable after at least 10 days of in-hospital intravenous appropriate antibiotic therapy 4.