What's the treatment for bacterial (or infective) endocarditis?
High dose antibiotics are administered by the intravenous route to maximize diffusion of antibiotic molecules into vegetation(s) from the blood filling the chambers of the heart. This is necessary because neither the heart valves nor the vegetations adherent to them are supplied by blood vessels. Antibiotics are continued for a long time, typically two to six weeks. The type of antibiotic and the length of therapy depend on the results of the blood cultures, which identify the species
of infecting bacteria and its sensitivity to specific antibiotics. In most cases, antibiotic treatment is given intravenously (through a vein) while you are hospitalized. However, certain highly motivated patients who have Streptococcus viridans endocarditis and stable heart function sometimes can be treated at home.
Surgical removal of the valve is necessary in patients who fail to clear micro-organisms from their blood in response to antibiotic therapy, or in patients who develop cardiac failure resulting from destruction of a valve by infection. A removed valve is usually replaced with an artificial valve which may either be mechanical (metallic) or obtained from an animal such as a pig; the latter are termed bioprosthetic valves. Infective endocarditis is assocaited with a 25% mortality.
Antibiotic prevention is recommended before procedures such as fibre optic examinations, dental procedures or surgical operations. The antibiotic used depends on the procedure. Details can be found on the endocarditis cards available from the British Heart Foundation. There are two types of cards: red cards detailing the standard antibiotic treatment and yellow cards for patients who are allergic to penicillin.
Dental procedures that cause bleeding from the gums (even a simple cleaning); rigid bronchoscopy; and surgery of the upper respiratory tract, urinary tract procedures, and gastrointestinal procedures all confer an increased risk of bacteremia, and therefore, an increased risk of infective endocarditis in those individuals with predisposing cardiac lesions. |
