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A review of current treatment strategies for infective endocarditis

David Luque Paz1, Ines Lakbar2, Pierre Tattevin1

  • 1Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.

Expert Review of Anti-Infective Therapy
|September 9, 2020
PubMed

Insights

This review details anti-infective treatments for infective endocarditis, focusing on key bacteria and treatment strategies like oral switch and duration. Optimal treatment durations are 4 weeks for native valves and 6 weeks for prosthetic valves.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Cardiology

Background:

  • Infective endocarditis presents significant treatment challenges.
  • Key bacterial culprits include staphylococci, streptococci, enterococci, and Gram-negative bacilli (including HACEK).

Purpose of the Study:

  • To review current anti-infective treatment strategies for infective endocarditis.
  • To cover critical aspects such as empirical treatment, oral switch therapy, and optimal treatment durations.

Main Methods:

  • A comprehensive literature search was conducted in the MEDLINE database.
  • Relevant studies, trials, reviews, and meta-analyses published until May 2020 were included.

Main Results:

  • Aminoglycoside use for endocarditis has decreased; recommended for once-daily, short-term (≤2 weeks) administration.
  • For staphylococcal endocarditis, anti-staphylococcal penicillins (or cefazolin) and vancomycin (or daptomycin) are recommended based on methicillin susceptibility.
  • Prosthetic-valve staphylococcal endocarditis requires gentamicin (2 weeks) and rifampin (6 weeks) in addition to primary agents.
  • Optimal treatment durations are 4 weeks for native valves and 6 weeks for prosthetic valves.
  • Oral switch therapy is safe for patients stabilized after initial intravenous treatment.

Conclusions:

  • Treatment strategies for infective endocarditis require careful consideration of bacterial type, resistance patterns, and valve status.
  • Optimized antibiotic regimens and durations, including the potential for oral switch, can improve patient outcomes.
Abstract

Keywords:
EndocarditisHACEKantibioticsempirical treatmententerococcioral treatmentreviewstaphylococcistreptococcitreatment

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