infective endocarditis valve 2

Question 1

Initial blind therapy native valve

Answer 1

amoxicillin, consider adding low-dose gentamicin

Question 2

Initial blind therapy native valve penicillin allergic, MSRA or severe sepsis

Answer 2

vancomycin + low-dose gentamicin

Question 3

initial blind therapy prosthetic valve

Answer 3

vancomycin + rifampicin + low-dose gentamicin

Question 4

Native valve endocarditis caused by staphylococci

Answer 4

Flucloxacillin

If penicillin allergic or MRSA
vancomycin + rifampicin

Question 5

Prosthetic valve endocarditis caused by staphylococci

Answer 5

Flucloxacillin + rifampicin + low-dose gentamicin

If penicillin allergic or MRSA
vancomycin + rifampicin + low-dose gentamicin

Question 6

Endocarditis caused by fully-sensitive streptococci (e.g. viridans)

Answer 6

Benzylpenicillin

If penicillin allergic
vancomycin + low-dose gentamicin

Question 7

Endocarditis caused by less sensitive streptococci

Answer 7

Benzylpenicillin + low-dose gentamicin

If penicillin allergic
vancomycin + low-dose gentamicin

Question 8

poor prognostic factors infective endocarditis

Answer 8

Staphylococcus aureus infection
prosthetic valve (especially ‘early’, acquired during surgery)
culture negative endocarditis
low complement levels

Question 9

mortality according to organism

Answer 9

staphylococci - 30%
bowel organisms - 15%
streptococci - 5%

Question 10

indications for surgery

Answer 10

severe valvular incompetence
aortic abscess (often indicated by a lengthening PR interval)
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy