Therapy
The treatment is carried out with antibiotics, as it is often triggered by bacterial pathogens. It is important to start the therapy early to avoid complications of the infection. Different antibiotics are used depending on whether the affected heart valve is the patient’s own original heart valve or a prosthetic valve.
In the case of endocarditis of the native valves – i.e. the patient’s own heart valves – for example, the antibiotics ampicillin-sulbactam, amoxicillin-clavulanic acid, ciprofloxacin and gentamicin are used. The same active ingredients are used for treatment if a valve prosthesis is affected after the first year after surgery. In this case the duration of therapy is usually four to six weeks.
If the valve operation was performed less than a year ago and the corresponding heart valve is then affected by endocarditis, the antibiotics vancomycin, rifampicin and gentamicin are preferred. Vancomycin and rifampicin are usually administered for six weeks or more, gentamicin for about two weeks. The therapy of endocarditis must be intravenous, i.e. the antibiotics are administered directly into a vein by means of an infusion.
Only in this way can enough of the active substance reach the heart valves so that the bacteria can be killed. This is because the heart valves themselves are not supplied with blood and the drugs therefore only reach their site of action through the blood flow through the heart cavities. Accordingly, patients with endocarditis are treated in hospital.
The success of the therapy must be monitored regularly. If the heart valve is severely affected, surgical repair may have to be considered in order to avoid complications. Otherwise, parts of the growths on the heart valve may come loose and cause, for example, strokes.
Even if there is a threat of heart failure or other complications, surgical therapy is often necessary. The guideline on endocarditis is regularly revised and adapted to the latest medical knowledge.The guideline contains recommendations for the treating physicians of patients with the corresponding disease and accordingly identifies the most proven diagnostic and therapeutic measures. The physicians are not bound by the guidelines, but can also use them merely as a guide. The guideline also provides recommendations for endocarditis prophylaxis and important hygienic measures to be observed in contact with patients suffering from endocarditis. The use of the guidelines is intended to improve the standardized care of patients with various diseases in general by making recommendations for diagnosis and therapy available to all physicians throughout the country.
