title: Swedish guidelines for diagnosis and treatment of infective endocarditis.
abstract: Swedish guidelines for diagnosis and treatment of infective endocarditis (IE) by consensus of experts are based on clinical experience and reports from the literature. Recommendations are evidence based. For diagnosis 3 blood cultures should be drawn; chest X-ray, electrocardiogram, and echocardiography preferably transoesophageal should be carried out. Blood cultures should be kept for 5 d and precede intravenous antibiotic therapy. In patients with native valves and suspicion of staphylococcal aetiology, cloxacillin and gentamicin should be given as empirical treatment. If non-staphylococcal etiology is most probable, penicillin G and gentamicin treatment should be started. In patients with prosthetic valves treatment with vancomycin, gentamicin and rifampicin is recommended. Patients with blood culture negative IE are recommended penicillin G (changed to cefuroxime in treatment failure) and gentamicin for native valve IE and vancomycin, gentamicin and rifampicin for prosthetic valve IE, respectively. Isolates of viridans group streptococci and enterococci should be subtyped and MIC should be determined for penicillin G and aminoglycosides. Antibiotic treatment should be chosen according to sensitivity pattern given 2-6 weeks intravenously. Cardiac valve surgery should be considered early, especially in patients with left-sided IE and/or prosthetic heart valves. Absolute indications for surgery are severe heart failure, paravalvular abscess, lack of response to antibiotic therapy, unstable prosthesis and multiple embolies. Follow-up echocardiography should be performed on clinical indications.
authors.affiliation: Infective Endocarditis Working Group, Swedish Society of Infectious Diseases, Sweden. Katarina.Westling@ki.se
authors.forename: Katarina
authors.initials: K
authors.lastname: Westling
authors.forename: Ewa
authors.initials: E
authors.lastname: Aufwerber
authors.forename: Christer
authors.initials: C
authors.lastname: Ekdahl
authors.forename: Göran
authors.initials: G
authors.lastname: Friman
authors.forename: Bengt
authors.initials: B
authors.lastname: Gårdlund
authors.forename: Inger
authors.initials: I
authors.lastname: Julander
authors.forename: Lars
authors.initials: L
authors.lastname: Olaison
authors.forename: Christina
authors.initials: C
authors.lastname: Olesund
authors.forename: Hanna
authors.initials: H
authors.lastname: Rundström
authors.forename: Ulrika
authors.initials: U
authors.lastname: Snygg-Martin
authors.forename: Anders
authors.initials: A
authors.lastname: Thalme
authors.forename: Maria
authors.initials: M
authors.lastname: Werner
authors.forename: Harriet
authors.initials: H
authors.lastname: Hogevik
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria; D004696:Endocarditis / Q000175:diagnosis* / Q000188:drug therapy*; D005658:Fungi; D006801:Humans; D017410:Practice Guidelines as Topic; D013548:Sweden
chemical_list: D000900:Anti-Bacterial Agents