General approach to empirical therapy for native valve infective endocarditis
Organisms that commonly cause native valve infective endocarditis include Staphylococcus aureus, viridans streptococci, coagulase-negative staphylococci, enterococci, Streptococcus bovis group (now classified as Streptococcus gallolyticus or Streptococcus infantarius) and the HACEK group of oral gram-negative bacilli. Other gram-negative bacteria and fungi are less common in the general population, but may be more likely in people who inject drugs. Blood culture–negative endocarditis is generally due to prior antibiotic therapy and so is not truly ‘culture-negative endocarditis’. However, also consider unusual pathogens or those that are difficult to grow as alternative causes (see Culture-negative endocarditis)Allen, 2020Chamat-Hedemand, 2020Ostergaard, 2022Primus, 2022Wang, 2018.
For information on assessing and managing infective endocarditis (including principles of antimicrobial therapy), see Principles of managing infective endocarditis.
Patients with infective endocarditis may have sepsis or septic shock. For patients with sepsis or septic shock, start antibiotic therapy within 1 hour of presentation to medical care or, for ward-based patients, development of sepsis or septic shock. Antibiotics should be administered immediately after blood samples are taken for culture. For nonantibiotic management of sepsis or septic shock, see Resuscitation of patients with sepsis or septic shock.
The following empirical regimens for native valve endocarditis are included in this topic: