Infective Endocarditis

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Antimicrobial therapy of Infective Endocarditis
Definition Signs/ Symptoms Management
Antibiotic Comment
Native valve endocarditis Fever, chills, anorexia , wieght loss, malaise, headache , myalagias, arthralgias, noght sweats, abdominal pain, dyspnea and cardiac murmurs.
  • Vancomycin 15 mg/kg/dose IV every 12 hours

PLUS

Select one of the following Antibiotics:

  • Ceftriaxone 2 g IV every 24 hours
  • ^Ampicillin/Sulbactam 3 g IV every 6 hours
    ^(IF oral or GI sources)
  • Cefepime 2 g IV every 8 hours*
  • Piperacillin/Tazobactam 4.5 g IV every 6 hours*
  • *(IF pseudomonas risk Factors)
 Empiric therapy should be administrated after at least two (preferably thee) sets of blood cultures from separate venipunctures, ideally spaced over 30- 60 minutes.
Prosthetic valve endocarditis

Vancomycin 15 mg/kg/dose IV every 12 hours

PLUS

Select one of the following Antibiotics:

Cefepime 2 g IV every 8 hours*

Piperacillin/Tazobactam 4.5 g IV every 6 hours

PLUS

*Gentamycin 3 mg/kg IV every 24 hours

*(IF MDR is common)
Duration: 4 - 6 Weeks, counted from the first day of negative blood culture.
References:

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications, last update 2018