Infective Endocarditis Treatment
Empirical antibiotic treatment - pending blood culture results - before pathogen identification (typically for less than 48hours)
- Micro/ID should be consulted in all cases of possible endocarditis
- Cardiology should be consulted in all cases of confirmed endocarditis and those where there is a high clinical suspicion pending further investigation.
- Ideally DO NOT start antibiotics until after discussion with Micro/ID.
- Ideally, take a minimum of 3 blood culture sets (6 bottles, 8-10ml per bottle) before antibiotic administration; if possible have a gap of at least 30min between sets.
- Antibiotic therapy should be refined based on blood culture results.
- True culture negative endocarditis is rare – Micro/ID will advise on-going treatment and investigation in such cases.
- Ensure penicillin allergy is properly investigated. Consider penicillin allergy assessment and delabelling
- Patients requiring aminoglycosides for 2 weeks or more for infective endocarditis: See Audiometry and intravenous aminoglycosides guidance.
Community acquired native valve OR late (more than 12 months post-surgery) prosthetic valve endocarditis
Preferred:
amoxicillin 2g iv every 4 hours
AND flucloxacillin 2g iv every 4 hours
AND gentamicin 3mg/kg iv od. For levels and dose adjustment see gentamicin Infective endocarditis monitoring guideline
For penicillin allergy (non-severe)
cefazolin* 2g tds iv
AND gentamicin 3mg/kg iv od. For levels and dose adjustment see gentamicin Infective endocarditis monitoring guideline
*Caution: Prothrombin time, INR and APTT may increase on cefazolin treatment courses, please monitor. For more information see Cefazolin associated coagulation disorders
For penicillin allergy (severe) OR MRSA positive patients
vancomycin iv see monograph for dosing
AND gentamicin 3mg/kg iv od. For levels and dose adjustment see gentamicin Infective endocarditis monitoring guideline
Nosocomial/healthcare associated or early prosthetic valve (less than 12 months post-surgery) endocarditis
Including implantable cardiac electronic device-associated endocarditis
Preferred (including penicillin allergy (severe and non-severe) and MRSA positive patients
vancomycin iv see monograph for dosing
AND gentamicin 3 mg/kg iv od. For levels and dose adjustment see gentamicin Infective endocarditis monitoring guideline
(rifampicin may be recommended by Micro/ID after 3-5 days)
References
This guideline is a summary of the European Society of Cardiology Guidelines for the management of endocarditis