Penicillin-susceptible viridans Streptococcus or Streptococcus bovis. Relatively penicillin-resistant viridans Streptococcus or S. Penicillin-resistant viridans Streptococcus or S. Nafcillin or oxacillin for six weeks, plus gentamicin for three to five days optional. Enterococcus strains susceptible to penicillin, gentamicin, and vancomycin. Enterococcus strains susceptible to penicillin, streptomycin, and vancomycin, and resistant to gentamicin.
Enterococcus strains resistant to penicillin, but susceptible to aminoglycosides and vancomycin. Information from reference For the purposes of determining duration of therapy, the first day in which negative blood cultures are obtained is considered the first day of therapy. At least two sets of blood cultures should be obtained every 24 to 48 hours until the infection has cleared the bloodstream. The structural and functional integrity of cardiac valves may be damaged by infection.
Anticoagulation in patients with infectious endocarditis is controversial, particularly in those with mechanical valve endocarditis. In general, anticoagulation should be discontinued for at least the first two weeks of antibiotic therapy in patients with Staphylococcus aureus prosthetic valve endocarditis who have experienced a recent central nervous system embolic event. Intravenous catheters should be removed promptly after antibiotic therapy is complete.
Transthoracic echocardiography should be performed to establish a new baseline. In patients with a history of infectious endocarditis, three sets of blood cultures should be obtained from separate sites before antibiotics are initiated for febrile illness. Patients should receive information about daily dental hygiene, regular visits to the dentist, and the need for antibiotic prophylaxis for certain procedures Table 4. Amoxicillin adults: 2 g; children: 50 mg per kg taken orally one hour before procedure.
Ampicillin adults: 2 g; children: 50 mg per kg IM or IV within 30 minutes of procedure. Clindamycin adults: mg; children: 20 mg per kg or azithromycin Zithromax or clarithromycin Biaxin; adults: mg; children: 15 mg per kg taken orally one hour before procedure. Clindamycin adults: mg; children: 20 mg per kg IV within 30 minutes of procedure. Cefazolin adults: 1 g; children: 50 mg per kg IM or IV or cephalexin Keflex; adults: 2 g; children: 50 mg per kg taken orally.
Antibiotic prophylaxis solely to prevent endocarditis is not recommended for genitourinary or gastrointestinal procedures. Prevention of infective endocarditis [published correction appears in Circulation. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Clinton Ave. Reprints are not available from the authors. Figure 1 provided by J.
Chad Teeters, MD. Eur Heart J. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study.
Arch Intern Med. Karchmer AW. Infectious endocarditis. Harrison's Principles of Internal Medicine. Underlying cardiac lesions in adults with infective endocarditis. The changing spectrum. Endocarditis in intravenous drug users. In: Kaye D, ed. Infective Endocarditis. Clinical features, site of involvement, bacteriologic findings, and outcome of infective endocarditis in intravenous drug users. Staphylococcus aureus endocarditis: clinical manifestations in addicts and nonaddicts.
Medicine Baltimore. Nosocomial endocarditis in a tertiary hospital: an increasing trend in native valve cases. Contemporary epidemiology and prognosis of health care-associated infective endocarditis. Clin Infect Dis. Bacterial endocarditis in hemodialysis patients. Am J Kidney Dis. Houpikian P, Raoult D.
Blood culture-negative endocarditis in a reference center: etiologic diagnosis of cases. Studies on the bacteremia of bacterial endocarditis. J Am Coll Cardiol.
Epidemiological trends of infective endocarditis: a population-based study in Olmsted County, Minnesota [published correction appears in Mayo Clin Proc. Mayo Clin Proc. Use of surgery in patients with native valve infective endocarditis: Results from the International Collaboration on Endocarditis Merged Database.
Am Heart J. This content is owned by the AAFP. The signs and symptoms of infectious endocarditis vary greatly from person to person.
They can change over time, and they depend on the cause of your infection, heart health, and how long the infection has been present. If you have a history of heart problems, heart surgery, or prior endocarditis, you should contact your doctor immediately if you have any of these symptoms. The main cause of endocarditis is an overgrowth of bacteria. Although these bacteria normally live on the inside or outside surfaces of your body, you might bring them inside to your bloodstream by eating or drinking.
Bacteria could also enter through cuts in your skin or oral cavity. Your immune system normally fights off germs before they cause a problem, but this process fails in some people. In the case of infective endocarditis, the germs travel through your bloodstream and into your heart, where they multiply and cause inflammation. Endocarditis can also be caused by fungi or other germs. They can also get into your bloodstream through:.
Your doctor will go over your symptoms and medical history before conducting any tests. The following tests may also be done:. If your doctor suspects you have endocarditis, a blood culture test will be ordered to confirm whether bacteria, fungi, or other microorganisms are causing it.
Other blood tests can also reveal if your symptoms are caused by another condition, such as anemia. A transthoracic echocardiogram is a non-radiating imaging test used to view your heart and its valves. This test uses ultrasound waves to create an image of your heart, with the imaging probe placed on the front of your chest. Your doctor can use this imaging test to look for signs of damage or abnormal movements of your heart. This is used to view your heart by way of your esophagus.
This test can detect an abnormal heart rhythm or rate. A technician will attach 12 to 15 soft electrodes to your skin. These electrodes are attached to electrical leads wires , which are then attached to the EKG machine. A collapsed lung or other lung problems can cause some of the same symptoms as endocarditis. A buildup of fluid is called pulmonary edema. The X-ray can help your doctor tell the difference between endocarditis and other conditions involving with your lungs.
If your endocarditis is caused by bacteria, it will be treated with intravenous antibiotic therapy. Your doctor will advise you to take antibiotics until your infection and related inflammation are effectively treated.
You will likely receive these in a hospital for at least a week, until you show signs of improvement. You will need to continue antibiotic therapy upon discharge from the hospital. You may be able to transition to oral antibiotics later in your treatment. They'll also listen to your heart using a stethoscope to see if you have developed a heart murmur.
A heart murmur is where your heartbeat has an extra or unusual sound caused by a disturbed blood flow through the heart. The symptoms of endocarditis are similar to those of some other health conditions, so it's important that other possible causes are ruled out. Blood tests may be used to help diagnose endocarditis or identify the most effective treatment. An echocardiogram uses sound waves to scan your heart.
The waves can produce accurate images of the heart muscle, chambers and valves. An echocardiogram is often used to check for any clumps of bacteria that may have formed, and can help detect infected or damaged heart tissue.
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