Evidence-based On-call

Infective endocarditis

Therapy

Give combination therapy (commonly an aminoglycoside and a broad-spectrum pencillin) ^c

preferably intravenously ^c

for at least 2 weeks ^c

(and probably for longer)

Note:

70% of patients with right-sided endocarditis are cured following 2 weeks of iv cloxacillin and gentamicin ^c
94% of selected patients with right-sided Staphylococcus endocarditis are treated safely and effectively with a 2-week course of nafcillin plus tobramycin. ^c
Oral antibiotics are not clearly as effective as intravenous antibiotics in intravenous drug users with right-sided staphylococcus endocarditis., though patients have less liver damage and kidney damage. ^c

Oral antibiotics increase the risk of liver or kidney damage.

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNH (95% CI)
right-sided infective endocarditis ^c	oral antibiotics	intravenous antibiotics	treatment failure at 1 month	12%	-56% (-290% to 95%)	15 (NNT = 4 to infinity NNH = 11 to infinity)
			hepatotoxicity during hospital stay	33%	-92% (-99% to -39%)	3 (2 to 7)
			nephrotoxicity during hospital stay	26%	-100%	4 (3 to 8)