ESC Endocarditis 2023

Question 1

Oral strep + Strep gallolyticus penicillin susceptible regime?

and beta lactam allergy?

Answer 1

1. NVE (non complicated)

4 weeks PenG/ CRO/ AMP or
2 weeks if combined with genta

2. PVE
   6 weeks PenG/ CRO/ AMP

3.Beta lactam allergy?
NVE - 4 weeks vanco
PVE - 6 weeks vanco

Question 2

Oral strep + Strep gallolyticus penicillin increased susceptibility/ increased exposure regime?

and beta lactam allergy?

Answer 2

1. NVE (non complicated)

4 weeks PenG/ CRO/ AMP AND
2 weeks genta

2. PVE
   6 weeks PenG/ CRO/ AMP AND 2 weeks genta

3.Beta lactam allergy?
NVE - 4 weeks vanco
PVE - 6 weeks vanco with genta

Question 3

MSSA endocarditis regime?

and beta lactam allergy?

Answer 3

1. NVE

4-6 weeks fluclox/ cefazolin

2. PVE

6 weeks fluclox/ cefazolin + rifampin AND genta 2 weeks

3. Betalactam allergy?

NVE 4-6 weeks cefazolin

PVE 6 weeks cefazolin + rifampin AND 2 weeks genta

Question 4

MRSA endocarditis regimen

Answer 4

1. NVE

4-6 weeks Vanco

2. PVE

6 weeks Vanco + rirampin AND 2 weeks genta

Question 5

Enterococcus with non HLAR endocarditis

Answer 5

1.NVE

6 weeks Amp or amox with cro but if combined with genta reduce whole to 2 weeks

2. PVE

6 weeks amp or amox with cro but if combined with genta reduce whole to 2 weeks

Question 6

Enterococcus with HLAR endocarditis

and allergy to beta lactam?

Answer 6

1. Both NVE and PVE

6 weeks amp or amox with cro

2. Allergy to beta lactam (esp E. faecium)

Both NVE and PVE 6 weeks vanco with genta 2 weeks

Question 7

VRE endocarditis regimen?

Answer 7

Daptomycin
+
beta lactam
(amp/ erta/ceftaroline)

or

Fosfomycin

Question 8

Yeast endocarditis regiment?

Answer 8

1. Candia IE

Echinocandin (high dose)

or

liposomal amph B
+/- flucytosine

2. Aspegillus IE

Voriconazole

Question 9

Brucella sp endocarditis treatment? Rx success?

Answer 9

Doxy + cotrim + rifampin for around 3-6 months oral

Rx success defined as antibody titre <1:60, some authors rec adding genta for first 3 weeks

Question 10

Coxiella burnetii (Q fever) endocarditis treatment? Rx success?

Answer 10

Doxy + hydroxychloroquine oral >18 months treatment

Rx success defined as anti phase I IgG titre <1:400 and IgA and IgM titres <1:50

Question 11

Bartonella endocarditis treatment?

Answer 11

Doxy oral 4 weeks + genta IV for 2 weeks

Question 12

Legionella endocarditis treatment?

Answer 12

Levo iv/oral for 6 weeks

or

clarithromycin iv 2 weeks, then oral + rifampin for 4 weeks

Question 13

Mycoplasma endocarditis treatment?

Answer 13

Levo iv or oral for 6 months

Question 14

Tropheryma whipplei endocarditis treatment? (whipples disease)

Answer 14

Doxy
+
dihydroxychloroquine oral for >18 months