Sandbox endocarditis

Empirical Antibiotic Therapy

• Although antibiotic therapy for subacute disease can be delayed till the result of blood culture, the delay in laboratory-based diagnostic techniques to detect the causing pathogens, beside bacterial endocarditis rapid progression necessitate that empirical treatment antibiotic therapy should be started once the blood culture have been collected

• Empirical therapy is needed for all likely pathogens, certain antibiotic agents, including aminoglycosides, is preferably avoided for its toxic effects.

• Clinical course of infection beside the epidemiological features should be considered upon selecting empirical treatment regimen.

Treatment Based Upon Infectious Agent

Penicillin-Susceptible Strep Viridans and Other Nonenterococcal Streptococci

Penicillin G

• If Minimum inhibitory concentration [MIC] <0.2 µg/ml.
• Dose: 12–18 million units I.V. daily in divided doses q. 4 hour for 4 weeks.

Penicillin G + Gentamicin

• Dose: Penicillin G, 12–18 million units I.V. daily in divided doses q. 4 hour for 4 weeks plus gentamicin, 3 mg/kg I.M. or I.V. daily in divided doses q. 8 hour for 2 weeks (peak serum concentration should be ~ 3 µg/ml and trough concentrations < 1 µg/ml).

Ceftriaxone

• Dose: 2 g I.V. daily as a single dose for 2 weeks.