[Acquired data on the antibiotic treatment of bacterial endocarditis on native or prosthetic valves].
Antimicrobial therapy of infective endocarditis is based on periodically updated expert recommendations that derive from both clinical and experimental data. Streptococcal and enterococcal endocarditis should be treated intravenously with a combination of penicillin+aminoglycoside in the absence of allergy to penicillin. The choice of either penicillin or ampicillin, the dose and the length of treatment plainly depend on susceptibility of streptococcal strain to penicillin. In patients allergic to penicillin, vancomycin is the optimal choice. The treatment of native valve meticillin-susceptible staphylococcal endocarditis is based on a combination of oxacillin or cefamandole+aminoglycoside. Vancomycin is recommended in case of allergy to penicillin and in meticillin resistant staphylococcal endocarditis. Prosthetic valve staphylococcal endocarditis are often due to meticillin-resistant coagulase negative staphylococci. Therefore they should be treated with vancomycin in combination with rifampicin and an aminoglycoside unless the strain is resistant to either of these 2 antibiotics. For the treatment of culture-negative endocarditis, different situations should be considered: in native valve endocarditis, the possible responsibility of deficient streptococci justifies an ampicillin+aminoglycoside combination; in recently implanted (< 1 year) prosthetic valve endocarditis a combination of vancomycin+rifampicin+aminoglycoside should be used because of the high probability of meticillinresistant staphylococci: if prosthetic valve is implanted for more than a year endocarditis may be due to streptococci, staphylococci and fastidious gram-negative bacilli; a combination of vancomycin+aminoglycoside +/- third generation cephalosporin is therefore recommended.
Hoen
B
B
Département de maladies infectieuses et tropicales, hôpitaux de Brabois, Vandoeuvre.
Leport
C
C
Carbon
C
C
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004697:Endocarditis, Bacterial / Q000188:drug therapy*; D006349:Heart Valve Diseases / Q000188:drug therapy*; D006350:Heart Valve Prosthesis; D006801:Humans
D000900:Anti-Bacterial Agents
Faits acquis dans le traitement antibiotique des endocardites bactériennes sur valve native et sur prothèse.