Infective Endocarditis

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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.

Indication for surgery include:
  • Extensive damage to a valve

  • Early infection of prosthetic material

  • Worsening renal failure

  • Persistant Infection but failure to culture an organism

  • Embolization

  • Large vegetations

  • Progressive cardiac failure

In general early surgery preferable.

Prognosis :
Factors that predispose to poor prognosis are
1. Non streptococcal disease
2. Development of heart failure
3. Aortic valve involvement
4. Infection on a prosthetic valve
5. Older age
6. Valve ring or myocardial abscess
About 10% will have additional episodes of endocarditis months or years later.

Antimicrobial prophylaxis of endocarditis:
Conditions in which prophylaxis is recommended are
1. Valvular or congenital heart disease (except uncomplicated ASD)
2. Intra cardiac prosthesis
3. Asymmetric septal hypertrophy
4. Previous endocarditis
5. MVP with regurgitation or thick valves which are redundant

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