Ambulatory antimicrobial therapy for infective endocarditis
After initial inpatient therapy (usually for at least 1 to 2 weeks or until the patient is medically stable), transfer to an established ambulatory antimicrobial therapy program1 is appropriate for selected patients with endocarditis. In addition to meeting all the general criteria for ambulatory antimicrobial therapy, patients with endocarditis must meet all of the following additional criteria:
- medically stable and responding to therapy, with no need for cardiac surgery
- no medical contraindications for ambulatory antimicrobial therapy
- afebrile for at least 72 hours with negative blood culture results
- no evidence of heart failure, or if heart failure present, it is stable and controlled with medical therapy
- small vegetations (eg less than 10 mm) and no intracardiac abscess or paravalvular extension on transoesophageal echocardiography (TOE)
- no new cardiac conduction abnormalities
- no neurological findings that could result from cerebral embolism or infected (mycotic) aneurysm
- no uncontrolled extracardiac infection
- continued supervision by a cardiologist and an infectious diseases physician or clinical microbiologist.
Particular care must be taken in patients with a form of endocarditis that often requires cardiac surgery (eg prosthetic valve endocarditis) and in patients with infection caused by virulent organisms such as Staphylococcus aureus, which has a high rate of complications and mortality.
Patients should be advised to seek medical attention if they develop symptoms of heart failure. Patients should be reviewed regularly (at least weekly) by an experienced clinician for symptoms and signs of heart failure.
For further information, see Ambulatory antimicrobial therapy.