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
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