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Antibiotic treatment of infective endocarditis

W R Wilson, J E Geraci

    Annual Review of Medicine
    |January 1, 1983
    PubMed

    Insights

    Effective therapy cures over 85% of infective endocarditis cases. Treatment varies by bacteria, with specific antibiotic regimens for streptococci and staphylococci infections.

    Area of Science:

    • Infectious Diseases
    • Cardiology
    • Pharmacology

    Background:

    • Infective endocarditis is a serious infection of the heart lining.
    • Streptococci and staphylococci are the most common causative agents, accounting for 75% of cases.
    • Successful treatment relies on accurate diagnosis and appropriate antimicrobial therapy.

    Purpose of the Study:

    • To outline effective therapeutic strategies for infective endocarditis.
    • To detail antibiotic choices based on specific bacterial pathogens.
    • To provide guidance on empiric therapy for urgent cases.

    Main Methods:

    • Review of established treatment protocols for infective endocarditis.
    • Categorization of treatment regimens by causative organism (Streptococci, Staphylococci).
    • Identification of recommended antibiotic classes and durations for various endocarditis types.

    Main Results:

    • Penicillin-sensitive viridans or nonenterococcal group D streptococcal endocarditis: treated with aqueous penicillin G for 4 weeks or penicillin/streptomycin for 2 weeks.
    • Enterococcal endocarditis: treated with aqueous penicillin G plus streptomycin or gentamicin for 4-6 weeks.
    • Staphylococcus aureus endocarditis: treated with nafcillin, oxacillin, cephalothin, or cefazolin for 4-6 weeks.
    • Empiric therapy for unidentified organisms: aqueous penicillin G, nafcillin, and gentamicin combination.

    Conclusions:

    • Infective endocarditis is highly curable with appropriate antimicrobial therapy, achieving cure rates over 85%.
    • Tailoring antibiotic treatment to the specific causative microorganism is crucial for successful outcomes.
    • A combination of aqueous penicillin G, nafcillin, and gentamicin provides effective empiric therapy when the pathogen is unknown.

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