Cardiology
Infective Endocarditis
Cardiology

Infective Endocarditis

Prophylaxis indications + IE management + perivalvular abscess.

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◆Prophylaxis indications (only these conditions)

  • •Prosthetic valve
  • •Prior infective endocarditis
  • •Unrepaired cyanotic congenital heart disease
  • •Mnemonic: SMURF (cyanotic) + TURF (roughed-up endocardium)
  • •MVP, MR, AS, etc. → NOT indications

◆Prophylaxis regimens

  • •Standard: amoxicillin 2 g PO 30–60 min before procedure
  • •Penicillin-allergic: doxycycline, azithromycin, clarithromycin, clindamycin (alternatives)

◆IE workup

  • •Always 3 blood cultures from different sites BEFORE antibiotics (if stable)
  • •IVDU IE: tricuspid valve most common; MRSA empirically (vancomycin)
  • •Non-IVDU native valve: vancomycin + ceftriaxone
  • •TEE > TTE for vegetation detection
  • •New AV block in IE → perivalvular abscess → urgent TEE + surgery

◆Surgical indications

  • •Heart failure from valve dysfunction
  • •Abscess (perivalvular)
  • •Refractory infection on appropriate abx
  • •Large vegetation (>10 mm) or recurrent emboli
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