Principles of therapy
Eradication of all micro organisms from the vegetation
Regimens including penicillins, cephalosporins and vancomycin given for better results then are obtained when these agents cannot be used.
Antibiotic administration should be parenteral to guarantee adequate absorption of drugs.
Specific antimicrobial regimens
Therapy before culture results are known
i) Sub acute infective endocarditis on a na tive valve – should cover enterococci.
ii) Acute course – staphylococcus aureus
iii)IVDA – S.aureus and gentamicin included for coverage of gram negative bacilli.
iv)Prosthetic valves – Vancomycin + gentamicin because of increased incidence of methicillin resistant staphylococcus epidermidis.
Extensive damage to a valve
Early infection of prosthetic material
Worsening renal failure
Persistant Infection but failure to culture an organism
Progressive cardiac failure
In general early surgery preferable.
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