What are the current antibiotic treatment guidelines for managing infective endocarditis in adults?

Antibiotic treatment for infective endocarditis in adults requires intravenous therapy in secondary care settings. Native valve endocarditis is generally treated first-line with intravenous vancomycin. For native tricuspid valve endocarditis, daptomycin may be used as an alternative. Prosthetic valve endocarditis requires combination therapy with intravenous vancomycin and gentamicin, along with oral rifampicin. Treatment duration and regimen should be guided by microbiological results and specialist advice due to the complexity and severity of the infection.

Persistent or complicated MRSA bacteraemia associated with endocarditis may require extended treatment duration and combination antibiotic therapy. Blood cultures should be monitored closely, and if bacteraemia persists beyond 3–5 days despite appropriate therapy and source control, alternative or additional antibiotics should be considered.

Prompt investigation and treatment of infections in people at risk of infective endocarditis is essential to reduce the risk of developing endocarditis. Antibiotic choice should cover organisms known to cause infective endocarditis, especially in patients undergoing procedures with suspected infection.