Infective Endocarditis

Question 1

Viridans Group Strep and Strep Gallolyticus - NATIVE Valve Endocarditis

Answer 1

• Highly PCN Sus (MIC<0.12): PCN G or Ceftriaxone (monoTx), PCN G or Ceftriaxone + Gent, or Vanc
• PCN Resistant: PCN G or Ceftriaxone + Gent, or Vanc
  2-4weeks

Question 2

Viridans Group Strep and Strep Galloyticus - PROSTHETIC Valve Endocarditis

Answer 2

• PCN Sus: PCN G or Ceftriaxone +/- Gent, or Vanc
• PCN Res: PCN + Gent, Ceftriaxone + Gent, or Vanc
  6 week

Question 3

Staphylococci - NATIVE Valve Endocarditis

Answer 3

• MSSA: Nafcillin, Oxacillin, or Cefazolin
• MRSA: Vanc or Dapto (D for right-sided IE only)
  6 weeks

Question 4

Staphylococci - PROSTHETIC Valve Endocarditis

Answer 4

• MSSA: Naf or Oxa + Rifampin + Gent
• MRSA: Vanc + Rifampin + Gent
  ≥6 weeks

Question 5

Enterococci - NATIVE or PROSTHETIC Valve Endocarditis

Answer 5

• PCN/Gent Sus: Amp + Gent, PCN + Gent OR (Amp +Ceftriaxone if CrCl <50)
• PCN Sus/Gent Res: Amp + Ceftriaxone
• PCN/Streptomycin Sus/Gent Res: Amp + Strepto, PCN + Strepto
• Can’t Tolerate PCN: Vanc + Gent
• Resistance to PCN: Vanc + Gent (or Unasyn + Gent if B-lactamase producer)
• PCN/Gent/Vanc Res: Dapto or Linezolid

Question 6

HACEK - NATIVE or PROSTHETIC Valve Endocarditis

Answer 6

• Ceftriaxone (1st)
• Unasyn
• Cipro IV/PO

Question 7

Fungal Endocarditis

Answer 7

Fluconazole (if candida or aspergillus spp.)

Question 8

Culture Negative Endocarditis - Native Valve Endocarditis

Answer 8

• Acute (days) onset: Vanc + Cefepime
• Subacute (weeks) onset: Vanc + Unasyn

Question 9

Culture Negative Endocarditis - Prosthetic Valve

Answer 9

• Early (<1 year): Vanc + Rifampin + Cefepime + Gent
• Late (>1 year): Vanc + Ceftriaxone

Question 10

Culture Negative Endocarditis - Suspected Bartonella (culture negative)

Answer 10

Ceftriaxone + Gent +/- Doxy

Question 11

Culture Negative Endocarditis - Suspected Bartonella (culture positive)

Answer 11

Doxy + Gent

Question 12

PTx for Dental Procedures agents (if Hx IE, prosthetic valves, heart disease, cardiac transplant)

Answer 12

• Amoxicillin PO
• NPO: Amp or Ceftriaxone/cefazolin
• PCN Ax: Ceflex, Clinda, azithro PO