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BMS 13091486
Drugs used in Infective Endocarditis
Infective endocarditis is microbial invasion of heart valves or mural endocardium (the lining
of the heart chamber wall)-often with destruction of the underlying cardiac tissues-
characteristically results in bulky, friable vegetations composed of necrotic debris, thrombus
and organisms. Infective endocarditis is a serious infection mandating prompt diagnosis and
In general, etiological agents that potentially cause infective endocarditis are Streptococcus
Viridans (50 - !0), Staphylococcus Aureus ("0-#0), Enterococci, HACEK related
species and rarely $ram negative bacilli.
%isk factors in general are &
'ental and surgical procedures that causes transient bacterimia
I( in)ection or contaminated materials particularly in I('*.
+n occult source from the gut, oral cavity or trivial in)uries will reach into the circulation.
,rosthetic heart valves and prosthetic materials used for cardiac valve repair.
,redisposing factors are also include -
Cardiac Abnora!i"i#$ % Ho$" &ac"or$ %
'a!()!ar abnora!i"i#$ * +#)"ro,#nia
Con-#ni"a! .#ar" di$#a$# * I)nod#/#nc0
1#-#n#ra"i(# .#ar" di$#a$# * Ma!i-nanc0
S"#ri!# ".robi on d#&or#d * A!co.o! con$),"ion
.#ar" (a!(# and ind2#!!in- ca".#"#r$ * 1iab#"ic
Clinical features :
Infective endocarditis may clinically presented as an acute, rapidly progressive infection, but
also as a subacute or chronic disease with low grade fever and non-speci.c symptoms which
may confuse initial assessment. *p to /0 of patients present with fever, often associated
with systemic symptoms of chills, poor appetite, and weight loss. 0hus, I1 should be
suspected in a variety of very different clinical situations such as -
2urmur 3 in /0 of patients with left sided lesions
4aneway lesions 3 painless erythematous lesion on palm or sole.
5sler nodes 3 painful, tender nodule on palm and sole (fingertips)
6plinter hemorrhage
%oths 6pot 3%etinal microthrombi and white centered hemorrhage.
Treatments :
+ntibiotic prophyla7is should only be considered for patients at highest risk of I1.
Patients with highest risk of IE classified in three categories as such
". ,atients with prosthetic heart valves or prosthetic devices for cardiac valve repair.
#. ,atients with previously deformed heart valves or I1.
33 ,atients with congenital heart diseases.
0he susceptibility for the infection also differs according to the type of the procedure at risk
which may or may not re8uire a prophyla7is.
0he following table summari9e the recommendation of prophyla7is according different type
of procedure at risk and alternative drug treatment.
Selection of antimicrobial agents :
Surgical treatment is used in appro7imately half of the patients with I1 due to severe
complications as in left sided native valve I1. 6evere complications are including aortic and
mitral severe regurgitation causing heart failure and valvular large vegetations following one
or more embolic episodes despite appropriate antibiotic therapy should where surgery should
be considered as to prevent embolism.In addition, complications due to locally uncontrolled
infection (false aneurysm and abscesses) that also caused by fungi and multi-resistant
organisms are also recommended for surgical treatment.
6urgical treatment is also recommended in right sided I1 where in conditions as
a) 2icroorganisms difficult to eradicate or bacteremia more than : days.
b) ,ersistent tricuspid heart valve vegetations after recurrent pulmonary embolism
c) %ight ;< secondary to severe tricuspid regurgitation with poor response to diuretic
". 2oreillon ,, =ue >+. Infective endocarditis. ?ancet #00@&A!A-"A/3"@/.
#. ;abib $. 2anagement of infective endocarditis. ;eart #00!&/#-"#@3"A0.
A. 2oulds %<, 4eyasingham 26. +ntibiotic prophyla7is against infective endocarditis-
time to rethink. 2ed 4 +ust #00B&"B/-A0"3A0#.
@. %ichey %, Cray ', 6tokes 0. ,rophyla7is against infective endocarditis- summary
of DIE1 guidance. F24 #00B&AA!-::03::".
5. Ehu (; 4r., Eabell E;, +brutyn 1, Eorey $%, ;oen F, 2iro 42, 5laison ?,
6try)ewski 21, ,appas ,, +nstrom G4, 1ykyn 6, ;abib $, Fenito D, <owler ($ 4r.
Dative valve endocarditis due to coagulase-negative staphylococci- report of //
episodes from the International Eollaboration on 1ndocarditis 2erged 'atabase. Elin
Infect 'is #00@&A/-"5#:3"5A0.
!. %evilla +, ?ope9 4, (ilacosta I, (illacorta 1, %ollan 24, 1chevarria 4%, Earrascal >,
'i 6tefano 6, <ul8uet 1, %odrigue9 1, <i9 ?, 6an %oman 4+. Elinical and prognostic
pro.le of patients with infective endocarditis who need urgent surgery. 1ur
;eart 4 #00:&#B-!53:".