Treatment of infective endocarditis

Discussion of whole list of options of antimicrobials for different varieties of endocarditis is quite a large topic. This discussion is only a broad outline of the antimicrobial treatment of infective endocarditis, meant mainly for exam purpose rather than actual clinical treatment. References to more detailed guidelines have been provided for those who wish to learn more. Inoculum Effect High microbial density as in vegetations cause less antimicrobial activity of some antimicrobial agents. This is known as inoculum effect and has been documented with β-lactams and glycopeptides but not linezolid, in the treatment of Staphylococcus aureus [2]. Inoculum effect is less with fluoroquinolones and aminoglycosides [1,3]. Need for bactericidal drugs Bactericidal drugs are needed to sterilize the vegetations of infective endocarditis which have high microbial density. Combination of β-lactams with aminoglycosides is useful in this context. Sometimes bactericidal effect can be obtained by the synergistic effect of bacteriostatic drugs. Need for prolonged therapy Need for prolonged antimicrobial therapy has been highlighted initially. This is needed because of the slow activity of most drugs against high bacterial density. But when the organisms are quite sensitive, shorter duration may be sufficient. One study has demonstrated that a 2 week course of ceftriaxone plus netilmicin can be useful in the treatment of streptococcal endocarditis [4]. But potential nephrotoxicity and ototo...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology Source Type: blogs