Treatment of Infective Endocarditis

Editorials15 March 1996Treatment of Infective EndocarditisDonald Kaye, MDDonald Kaye, MDMedical College of Pennsylvania and Hahnemann, University, Philadelphia, PA 19102-1192Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-6-199603150-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The American Heart Association's recently published recommendations for treating infective endocarditis [1] contain many substantial changes from the previous version [2].The first major change is the addition of a regimen suitable for outpatient treatment of infective endocarditis in patients with strains of streptococci that are highly susceptible to penicillin. This regimen consists of ceftriaxone, 2 g administered intravenously or intramuscularly once daily for 4 weeks. In the past, outpatient treatment with oral agents was not advocated because of the possibility of variable absorption of agents and lack of patient compliance. Furthermore, the previously used parenteral regimens for home therapy ...References1. Wilson WR, Karchmer AW, Dajani AS, Taubert KA, Bayer A, Kaye D, et al. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. JAMA. 1995; 274:1706-13. Google Scholar2. Bisno AL, Dismukes WE, Durack DT, Kaplan EL, Karchmer AW, Kaye D, et al. Antimicrobial treatment of infective endocarditis due to viridans streptococci, enterococci, and staphylococci. JAMA. 1989; 261:1471-7. Google Scholar3. Stamboulian D, Bonvehi P, Arevalo C, Bologna R, Cassetti I, Scilingo V, et al. Antibiotic management of outpatients with endocarditis due to penicillin-susceptible streptococci. Rev Infect Dis. 1991; 13(Suppl 2):S 160-3. Google Scholar4. 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Right-sided Staphylococcus aureus endocarditis in intravenous drug abusers: two-week combination therapy. Ann Intern Med. 1988; 109:619-24. Google Scholar10. Espinosa FJ, Valdes M, Martin-Luengo F, Arribas JP, Albaladejo J, Perez-Gracia A, et al. Endocarditis derecha por Staphylococcus aureus en adictos a drogas por via parenteral: valoracion de un regimen terapeutico combinado de 2 semanas frente al tratamiento convencional. [Right endocarditis caused by a Staphylococcus aureus in parenteral drug addicts: evaluation of a combined therapeutic scheme for 2 weeks versus conventional treatment.] Enferm Infecc Microbiol Clin. 1993; 11:235-40. Google Scholar11. Tores-Tortosa M, de Cueto M, Vergara A, Sanchez-Porto A, Perez-Guzman E, Gonzalez-Serrano M, et al. Prospective evaluation of a two-week course of intravenous antibiotics in intravenous drug addicts with infective endocarditis. Grupo de Estudio de Enfermedades Infecciosas de la Provincia de Cadiz. Eur J Clin Microbiol Infect Dis. 1994; 13:559-64. Google Scholar12. Levine DP, Fromm BS, Reddy BR. Slow response to vancomycin or vancomycin plus rifampin in methicillin-resistant Staphylococcus aureus endocarditis. Ann Intern Med. 1991; 115:674-80. Google Scholar13. Small PM, Chambers HF. Vancomycin for Staphylococcus aureus endocarditis in intravenous drug users. Antimicrob Agents Chemother. 1990; 34:1227-31. Google Scholar14. Mortara LA, Bayer AS. Staphylococcus aureus bacteremia and endocarditis. New diagnostic and therapeutic concepts. Infect Dis Clinics North Am. 1993; 7:53-68. Google Scholar15. DiNubile MJ. Short-course antibiotic therapy for right-sided endocarditis caused by Staphylococcus aureus in injection drug users. Ann Intern Med. 1994; 121:873-6. Google Scholar Author, Article, and Disclosure InformationAffiliations: Medical College of Pennsylvania and Hahnemann, University, Philadelphia, PA 19102-1192Corresponding Author: Donald Kaye, MD, Medical College of Pennsylvania and Hahnemann University, Broad and Vine Streets, Mail Stop 400, Philadelphia, PA 19102. 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