Endocarditis - Treating endocarditis

Most cases of endocarditis can be treated with a course of antibiotics. You will usually have to be admitted to hospital so that the antibiotics can be given through a drip in your arm (intravenously).

While you are in hospital, blood samples will be taken regularly to see how well the treatment is working. When any fever and any severe symptoms subside, you may be able to leave hospital and continue taking your antibiotics at home.

If you are taking antibiotics at home, you should have regular appointments with your GP to check that the treatment is working and that you are not experiencing any side effects. The antibiotics you will usually be prescribed are penicillin and gentamicin.

However, if you are allergic to penicillin, you may be prescribed vancomycin instead.

Vancomycin may also be used if tests reveal that your infection is caused by bacteria that have developed a resistance to penicillin and gentamicin, such as the meticillin-resistant staphylococcus aureus (MRSA) strain of bacteria.

Depending on the severity of your condition, you will usually have to take these antibiotics for between two and six weeks. It is likely that your doctor will take a blood sample before prescribing antibiotics. This is because the antibiotics must be specific to the bacteria causing the infection. If your blood sample shows that fungi are causing your infection, you will be prescribed an antifungal medicine.

If your symptoms are particularly severe, you will initially be prescribed a mixture of different antibiotics before the results of the blood samples become known. This is a precautionary measure to prevent your symptoms becoming worse. Once the results of the blood samples are known, you will be given a specific antibiotic (or antifungal).

Surgery

Endocarditis can cause serious damage to your heart. You may be referred to a cardiologist (a specialist in diseases of the heart and blood vessels) so the condition of your heart can be assessed more thoroughly.

Between 15% and 25% of people with endocarditis will need some form of surgery. This is usually to repair damage to the heart. Surgery will usually be recommended if:

your symptoms and/or test results suggest that you have experienced heart failure (a serious condition where your heart is not pumping blood around your body efficiently)
you continue to have a high temperature (fever) despite treatment with antibiotics or antifungals
your endocarditis is caused by particularly aggressive fungi or drug-resistant bacteria
you experience one or more blood clots despite treatment with antibiotics or antifungals
you have a prosthetic (artificial) heart valve
the results of your echocardiogram suggest that an abscess (a collection of pus) or a fistula (an abnormal passageway) has developed inside your heart

The three main surgical procedures that are used to treat endocarditis are:

the repair of the damaged heart valve
the replacement of the damaged heart valves with prosthetic ones
the draining of any abscesses and the repair of any fistulas that may have developed in the heart muscle

Surgery for endocarditis can be very challenging, not least because a person who needs surgery will usually be very ill to begin with. Despite the best efforts of their surgical teams, approximately one in 10 people will die during or shortly after surgery for endocarditis.

Abscesses: An abscess is a lump containing pus, which is made by the body during infection.
Antibiotic: Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Antifungal: Antifungal medicine is used to treat fungal infections. For example, clotrimazole and ketoconazole.
Bacteria: Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Blood: Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Heart valve: Heart valves are four sets of flaps that control the direction that blood pumps around the heart.
Intravenous: Intravenous (IV) means the injection of blood, drugs or fluids into the bloodstream through a vein.
Tissue: Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.