How is endocarditis treated?
The therapy of endocarditis consists of the administration of high-dose antibiotics. To optimize the therapy, it is necessary to isolate the triggering pathogens from the blood and determine them in a microbiological laboratory. Therefore, repeated blood sampling at intervals of one to two hours is unavoidable.
The detection of pathogens of the so-called HACEK – group (this is a group of bacteria, which is naturally located in the mouth and throat area, has a particularly slow growth and is responsible for about 5 to 10 percent of all inflammations of the inner heart wall) is particularly time-consuming. HACEK stands for: Initially, the antibiotic therapy of endocarditis is carried out intravenously (i.v., i.e. via the vein), in order to achieve high levels of the antibiotic in the blood as quickly and permanently as possible and thus to achieve a maximum effect against the bacteria. It usually takes 4 to 6 weeks for the antibiotic to heal. A therapy with an antibiotic sometimes has to be carried out for much longer.
- Haemophilus influenzae, parainfluenzae and aprophilus
- Actinobacillus
- Cardiobacterium
- Eicenella
- Klingella.
Duration of the therapy
Endocarditis is a serious infection, the therapy must be carried out for a long time, two to six weeks are the minimum. If a patient has artificial heart valves, the duration of antibiotic therapy must also be extended to eight weeks, depending on the pathogen. If a patient’s natural heart valves are severely damaged or completely destroyed by endocarditis, cardiac surgery becomes necessary, which prolongs the therapy and the time to recovery.
Which antibiotics are used?
The antibiotic therapy is carried out in two stages. If the doctor suspects endocarditis, the possible pathogen is not yet known. Therefore, a broad therapy is started.
This therapy includes ceftriaxone, gentamicin and vancomycin, three antibiotics with a very broad spectrum of activity. By repeatedly taking blood cultures, a pathogen can be found in 80-90% of cases and the antibiotics used can be adjusted. Typically, the following antibiotics are used in the treatment of endocarditis: penicillin G or ceftriaxone in penicillin-sensitive streptococci.
Penicillin-resistant streptococci and enterococci are treated with ampicillin and gentamicin, staphylococci with flucloxacillin or oxacillin, and vancomycin is used for methicillin resistance. In the case of artificial heart valves, antibiotics with a stronger effect and/or a broader spectrum of action must be used in addition to the antibiotics mentioned above; the use of gentamicin, vancomycin and rifampicin is therefore more frequent. For each pathogen, depending on the presence of an artificial heart valve or not, a specific combination of antibiotics is particularly suitable.
