From the Guidelines
The first-line treatment for infective endocarditis is antibiotic therapy, which should be started promptly after drawing three sets of blood cultures at 30-min intervals 1.
Empirical Treatment Regimens
The initial choice of empirical treatment depends on several considerations, including whether the patient has received previous antibiotic therapy, whether the infection affects a native valve or a prosthesis, and the place of the infection (community, nosocomial, or non-nosocomial healthcare-associated IE) 1.
- For community-acquired native valves or late prosthetic valves (≥12 months post surgery) endocarditis, proposed antibiotic regimens include:
- Ampicillin 12 g/day i.v. in 4–6 doses
- (Flu)cloxacillin or oxacillin 12 g/day i.v. in 4–6 doses
- Gentamicin 3 mg/kg/day i.v. or i.m. in 1 dose
- Vancomycin 30–60 mg/kg/day i.v. in 2–3 doses for penicillin-allergic patients 1
- For early PVE (<12 months post surgery) or nosocomial and non-nosocomial healthcare associated endocarditis, proposed antibiotic regimens include:
- Vancomycin 30 mg/kg/day i.v. in 2 doses
- Gentamicin 3 mg/kg/day i.v. or i.m. in 1 dose
- Rifampin 900–1200 mg i.v. or orally in 2 or 3 divided doses 1
Duration of Treatment
The duration of treatment for infective endocarditis is typically 4-6 weeks, but may vary depending on the specific pathogen and the patient's response to treatment 1.
Consultation with an Infectious Diseases Specialist
Consultation with an infectious diseases specialist is recommended to define the most appropriate choice of therapy, especially in cases of culture-negative endocarditis or when the patient has received previous antibiotic therapy 1.
Monitoring and Adjustment of Treatment
Monitoring of gentamicin or vancomycin dosages is crucial to avoid toxicity, and treatment should be adjusted based on the patient's response and the results of blood cultures 1.
From the Research
First-Line Treatment for Infective Endocarditis
The first-line treatment for infective endocarditis involves a combination of anti-microbial therapy and close monitoring by a multidisciplinary team of specialists, including cardiologists, microbiologists, and cardiac surgeons 2, 3, 4.
Anti-Microbial Therapy
- Intravenous antibiotics are the primary treatment for infective endocarditis, with the specific antibiotic regimen adapted to the responsible germ 3, 4.
- The duration of antibiotic therapy is typically prolonged, with a minimum of two weeks of parenteral antibiotic therapy initiated in the hospital 4.
- Outpatient antibiotic treatment may be considered depending on the patient's evolution, and oral antibiotics may be proposed in stable patients when the infection is caused by common germs 4.
Surgical Intervention
- Surgical treatment is reserved for certain complications of infective endocarditis, such as heart failure, uncontrolled infection, and prevention of embolic risk 3, 4.
- The surgical treatment aims to excise the infected tissues and restore valvular function, with conservative surgical treatment performed when possible, and valve replacement as an alternative 4.
- The recognition of surgical indications is essential to improve the prognosis of patients with infective endocarditis 4.