• Streptococci (most common)

Viridans Streptococci (with underlying lesion)

• Enterococcus faecalis
• Staphylococci

S.aureus (IVDA, abcess development, can occur on normal valves

S. epidermidis (prosthetic heart valves)

• Gram Negatives (rare) - increased in IVDA, patients with prosthetic valves
• Fungi

• Prosthetic valves
• History of IE
• IV drug use
• DM
• Long-term hemodialysis
• Poor dental hygiene
• Pre-existing cardiac valvular abnormalities (rheumatic heart dz, Mitral Valve Prolapse)

1. Fever
2. Chills
3. Weakness
4. Shortness of breath
5. Night sweats
6. Weight loss
7. Malaise

Cardiac

(murmur, valvular dysfunction, stenosis, abscesses, CHF, pericarditis, MI)

Renal

(abscesses, infarction, glomerular nephropathy, proteinuria, hematuria)

Brain

(emboli, infarction, abscess, SAH)

Spleen

(embolization, infarction, splenomegaly)

Lungs

(septic PE, pneumonia, empyema)

Skin

(petechiae, Osler's nodes, Janeway lesions, splinter hemorrhages)

Eye

(Roth's spots)

Musculoskeletal

(backache)

• Anemia
• Thrombocytopenia
• Mild leukocytosis
• Increased ESR

Transthoracic Echocardiogram

Transesophageal Echocardiogram

Penicillin G (4 weeks)

Or

Ceftriaxone (4 weeks)

 +/-

Gentamicin (synergy - 2 weeks)

Vancomycin can be used by itself (for severe allergy - 4 weeks)

Penicillin G (4 weeks)

Or

Ceftriaxone (4 weeks)

Each +

Gentamicin (for synergy - 2 weeks)

Vancomycin can be used by itself (4 weeks)

Penicillin G (6 weeks)

Or

Ceftriaxone (6 weeks)

+/-

Gentamicin (for synergy - 2 weeks)

Vancomycin can be used by itself (6 weeks)

Penicillin G (6 weeks)

Or

Ceftriaxone (6 weeks)

+

Gentamicin (for synergy - 6 weeks)

Vancomycin can be used by itself (6 weeks)

Nafcillin/Oxacillin (6 weeks)

Or

Cefazolin (6 weeks)

+/-

Gentamicin (3-5 days)

Vancomycin for MRSA (6 weeks)

Nafcillin/Oxacillin (> 6 weeks)

+

Rifampin (> 6 weeks)

+

Gentamicin (2 weeks)

Vancomycin (> 6 weeks)

+

Rifampin (> 6 weeks)

+

Gentamicin (2 weeks)

4 weeks for native, 6 weeks for prosthetic

Penicillin (4-6 weeks)

Or

Ampicillin (4-6 weeks)

Or

Vancomycin (6 weeks)

+

Gentamicin (4-6 weeks)

Or

Streptomycin (4-6 weeks)

• Symptoms based
• Microbiologic eradication (daily until negative, 8 weeks after tx)
• Serial ESR (every 7-30 days)
• Drug-specific