Bactericidal agents are necessary for effective treatment of endocarditis. Therefore, antimicrobial therapy should be dosed to optimize sustained bactericidal serum concentrations throughout as much of the dosing interval as possible. Infectious Diseases Cosultation is strongly advised.
Therapy for infective endocarditis (IE) should be targeted to the organism isolated from blood cultures; cultures are positive in over 90 percent of patients with IE. For patients with suspected IE who present without acute symptoms, empiric therapy is not always necessary, and therapy can await blood culture results.
For acutely ill patients with signs and symptoms strongly suggestive of IE, empiric therapy may be necessary. Such empiric therapy should be administered ONLY after at least two (preferably three) sets of blood cultures have been obtained from separate venipunctures.
Early consultation with a cardiac surgeon should be obtained for all cases in which complications are observed or expected (such as in the presence of moderate to severe heart failure or heart block or systemic emboli).
Streptococci (Penicillin MIC < 0.12 mcg/ml)
Streptococci (Penicillin MIC > 0.12 mcg/ml)