Bacterial Endocarditis Treatment
- Consult promptly with Infectious Diseases or Cardiology regarding treatment.
- Blood cultures (3 venepunctures) must be taken before antimicrobials are given. Take 6 blood cultures (6 venepunctures) if antimicrobials have been given within the last 2 weeks. Complete clinical details on request form.
- See investigation and treatment guidelines in Hospital HealthPathways.
Pathogens
- Native valves:
- Common: Viridans streptococci, S. aureus, enterococci
- Other: Gram-negative bacilli, HACEK (Haemophilus, Aggregatibacter (Actinobacillus), Cardiobacterium, Eikenella, Kingella)
- Prosthetic valves:
- As above plus Coagulase-negative staphylococci
Drug treatment
- Gentamicin is used for synergy so doses and target concentrations are lower than for other indications.
- Treatment duration varies from 2 to 6 weeks.
- Rationalise treatment once organism is identified and susceptibilities are known.
- Consult with Infectious Diseases.
Empiric
Native valve
- fe = 0.8. If CrCl < 30 mL/min, seek advice from infectious diseases/pharmacy.
AND
- fe = 0.7. If CrCl < 30 mL/min, seek advice from infectious diseases/pharmacy.
- Risk of hepatotoxicity is increased in females, patients > 55 years old, high doses, and courses longer than 14 days duration.
AND
Mild penicillin allergy
- fe = 0.9. If CrCl < 30 mL/min, seek advice from infectious diseases/pharmacy.
AND
Severe penicillin allergy
- fe = 0.9, adjust dose if CrCl reduced.
- Must be given diluted (1 g in at least 200 mL) and slowly (≤ 1000 mg/hour) to minimise infusion reactions.
AND
Prosthetic valves, implantable cardiac devices, or hospital-acquired endocarditis
- fe = 0.7. If CrCl < 30 mL/min, seek advice from infectious diseases/pharmacy.
- Risk of hepatotoxicity is increased in females, patients > 55 years old, high doses, and courses longer than 14 days duration.
AND
- fe = 0.9, adjust dose if CrCl reduced.
- Must be given diluted (1 g in at least 200 mL) and slowly (≤ 1000 mg/hour) to minimise infusion reactions.
AND
Penicillin allergy
Consult Infectious Diseases/Clinical Microbiology.
Pathogens Known
Consult Infectious Diseases/Clinical Microbiology.
Topic Code: 99217