Antibacterial therapy for infective endocarditis: сurrent approaches and prospects

Despite the progress in treatment approaches, infective endocarditis remains a severe life-threatening disease with high mortality rate. Growing antibiotic resistance, as well as the ability of microorganisms to form biofilms, complicate the treatment of this disease. The available guidelines emphasize the need for early initiation of empirical antibiotic therapy immediately after blood sampling for bacteria culture test, followed by correction depending on the sensitivity of microorganisms. Combinations of intravenous broad-spectrum bactericidal antibiotics effective against bacteria in biofilms are used. The issue of switching from intravenous forms of antibiotics to outpatient oral therapy is actively discussed in literature. The key problems in treatment of infective endocarditis at the present stage are the tolerance of microorganisms capable of forming biofilms to ongoing treatment and the growth of antibiotic resistance. Improved microbiological diagnostics, introduction of new therapeutic strategies, and compliance with clinical guidelines are necessary to improve outcomes of infective endocarditis. Individual characteristics of the patient, characteristics of the pathogen, and possible risk factors should be taken into account. The combined effect of antibacterial drugs, both “traditional” and “new”, as well as the use of drugs that do not belong to the antibacterial group, may significantly increase survival and reduce the number of complications in patients with infective endocarditis.