Therapeutic Targets
- Avoidance of complications
- Healing of the disease
Therapy recommendations
- Therapy for endocarditis depends on the etiology (cause).
- Abacterial endocarditis: therapy of the underlying disease.
- Infective endocarditis: intravenous antibiotics as first-line therapy (start immediately after blood cultures are taken):
- Initially calculated until blood culture results, then therapy correction if necessary.
- In clinically stable patients, the result of laboratory diagnostics can be waited.
- Involve cardiac surgeons in a timely manner to plan valve replacement as an ultima ratio therapy (last diagnostic option to still make progress in the treatment of the disease).Patients with infective endocarditis have a higher chance of survival if they are operated on early. This is the finding of a worldwide international group of researchers (International Collaboration on Endocarditis (ICE)). More than 80% of those operated on early survived the six-month period after surgery, while 31.4% of those not operated on did not.
- Initially calculated until blood culture results, then therapy correction if necessary.
- Duration of antibiotic therapy: continued therapy for another 4-6 weeks even after clinical or biochemical signs of inflammation had decreased.
Further notes
- In a study of patients with left heart endocarditis (aortic and/or mitral valve) infected with any of the following four bacteria: Streptococcus, Enterococcus faecalis, Staphylococcus aureus, coagulase-negative staphylococcus, a switch to oral therapy was ventured after approximately 2 weeks. The therapy was then continued orally for another 17 days. Patients could thus be discharged from the hospital after only 3 days. In contrast, the intravenously treated patients spent an average of 19 days in the hospital.Results: the follow-up after 6 months showed 13 deaths in the intravenously treated group compared to only 7 deaths in the orally treated group. In both groups, 3 patients each suffered a beneficial event and 5 patients each had a recurrence with the same pathogen. Furthermore, both groups required unplanned cardiac surgery. The primary endpoint comprising all events did not differ significantly.
- The first methicillin-resistant Staphylococcus aureus (MRSA) strain unaffected by the backup antibiotic vancomycin has emerged in Brazil
- Evaluation of a paradigm shift from intravenous antibiotics to oral step-down therapy for the treatment of infective endocarditis: early switching from standard intravenous to oral antibiotic therapy is at least as effective and possibly safer than an intravenous-only approach. This is true in the following circumstances:
- The patient must be clinically stable and there must be no immediate indication for cardiac surgery.
- Initial intravenous antibiotic therapy has cleared bacteremia.
- There are no psychosocial reasons to prefer intravenous therapy based on behavior or care situation.
- The available bioavailable oral antibiotics are sensitive to the pathogen and this confirmed by clinical studies.
