What Are Antibiotic Prophylactic Regimens for Endocarditis?

Symptoms of endocarditis include:

• Fever 
• Chills
• Shortness of breath/trouble breathing
• Swelling in the legs or feet
• Heart murmur
• Night sweats
• Headaches
• Fatigue
• Muscle and joint pain
• Cough 
• Small red or purple spots on the skin (petechiae)
• Confusion
• Weight loss
• Red or brown urine (if there is kidney damage)
• Trouble speaking; weakness or numbness in one or both arms (if a stroke occurs)

Endocarditis is usually caused by bacteria. Bacteria can enter the bloodstream and affect the lining of the heart in a number of ways, such as:

• Through a cut or scrape on the skin
• Via a medical or dental procedure
• Tooth or gum infection
• Intravenous drug use
• Urinary catheter
• Sexually transmitted infection (STI)

In rare cases, fungal infections can cause endocarditis. 

People who have a pre-existing heart problem or past heart valve surgery are often more prone to developing endocarditis because heart valves may be damaged.

Endocarditis is diagnosed with a history and physical exam, which will include the healthcare professional listening to the heart with a stethoscope to detect a heart murmur, which can be a sign of endocarditis. 

Other tests used to diagnose endocarditis include:

• Blood tests
  • Blood culture
  • Erythrocyte sedimentation rate (ESR)  
  • C reactive protein (CRP)  
• Chest X-ray
• Electrocardiogram (ECG or EKG)
• Echocardiogram ("echo") 
• Computerized tomography (CT) scan

Endocarditis is usually treated in a hospital with intravenous antibiotics.

If antibiotics do not work, or the infection causes heart valve problems, surgery to replace the diseased heart valve may be indicated.

Complications of endocarditis include: 

• Congestive heart failure (CHF) 
• Periannular abscesses 
• Chest pain 
• Cardiac tamponade
• Intracardiac fistula
• Systemic embolization 
• Neurological complications 
  • Stroke
  • Brain abscess  
  • Meningitis
  • Acute encephalopathy
  • Meningoencephalitis
  • Cerebral hemorrhage (due to stroke or a ruptured mycotic aneurysm)
  • Seizures 
• Renal infarction or abscess
• Lung infection
• Musculoskeletal complications 
  • Vertebral osteomyelitis 
  • Septic arthritis
• Splenic abscess (rare)
• Mycotic aneurysms (rare)

Antibiotic prophylactic regimens may be used to prevent endocarditis in at-risk patients before certain surgical or dental procedures. 

The American Heart Association Guidelines for Prevention of Infective Endocarditis are used in patients with underlying heart conditions associated with the highest risk of adverse outcome from infective endocarditis. 

High-risk cardiac conditions include: 

• Prosthetic cardiac valve  
• History of infective endocarditis 
• Congenital heart disease 
• Cardiac transplantation recipients with cardiac valvular disease