1. Endocarditis: Treatment
Shannon Famenini

2. Objectives
Know how to treat native valve and prosthetic valve endocarditis
Know the indications and treatments for prophylaxis in endocarditis

3. Treatment in native valve endocarditis
Organism
Treatment
Streptococcus viridans
Penicillin G units Q24h
Ampicillin 2g IV Q4h
Ceftriaxone 2g Q24h
Vancomycin 30 mg/kg Q24h
Streptococcus bovis
Same as above
Streptococcus pneumoniae
Penicilin G units Q24h
Cefazolin 2g Q8h
Enterococcus
Ampicilliln 2g IV Q4h or +
Gentamicin

4. Treatment in native valve endocarditis
Organism
treatment
MSSA
Nafcillin 3g Q6h
Oxacillin 3g Q6h
Cefazolin 2g Q8h
MRSA
Vanocmycin
Daptomycin
HACEK organisms
Ceftriaxone 2g Q24h
Ciprofloxacin 500 mg Q12h

5. Treatment in Prosthetic Valve Endocarditis
Organism
treatment
MSSA
Nafcillin or oxacillin 2g Q24h Or
Cefazolin 2gQ8h +
Rifampin 300 mg Q8h
Gentamicin 3mg/kg/24 hrs in 2-3 doses
MRSA
Vancomycin 30 mg/kg Q24h
Gentamicin 3mg/kg Q24hrs in 2-3 weeks

6. Treatment in prosthetic valve
organism
treatment
Streptococcus viridans
Penicillin G million units Q24h or
Ampicillin 2g IV Q4h
Ceftriaxone 2g Q24h
+/-
Gentamicin 3 mg/kg Q24h
Enteroccocus
Penicillin G million units Q4h +
Gentamicin
HACEK
Ciprofloxacin 500 mg Q12h

7. Who should receive prophylaxis?
HIGH RISK PATIENTS undergoing HIGH RISK PROCEDURES should receive prophylaxis.

8. High Risk Patients
Patients with prosthetic heart valves, including mechanical and bioprosthetic valves
A prior history of IE
Unrepaired cyanotic congenital heart disease
Repaired congenital heart disease with residual shunts or valvular regurgitation at the site or adjacent to the site of the prosthetic valve
Valve regurgitation due to a structurally abnormal valve in a transplanted patient

9. High Risk Procedures
Dental Work (examples: tooth extractions, drainage of dental abscess, routine dental cleaning)
Procedures that involve incision or biopsy of the respiratory tract mucosa (examples: tonsillectomy, adenoidectomy, bronchoscopy with biopsy)
Procedures on infected skin, skin structure, or musculoskeletal tissue
GI or GU procedures in patients with ongoing GI or GU tract infection
Surgery to place prosthetic heart valve or prosthetic intravascular or intracardiac material

10. Prophylaxis Situation Agent Regimen Oral Amoxicillin 2 g
Unable to take oral medication
Ampicillin OR
Cefazolin/Ceftriaxone
2g IM or IV
1 g IM or IV
Allergic to penicillin
Cephalexin
Clindamycin
Azithromycin/Clarithromycin 2g
600 mg
500 mg
Allergic to penicillin and unable to take oral medication
Cefazolin or ceftriaxone
Vancomycin
600 mg IM or IV
15-20 mg/kg

11. Case In which of the cases is prophylaxis indicated?
Man with bicuspid aortic valve undergoing dental cleaning
Man with history of cardiac valve repair undergoing colonoscopy
Woman with prior history of IE undergoing vaginal delivery
Man with prosthetic heart valve undergoing extraction of a tooth abscess
The correct answer is D!

12. The END!