Infective endocarditis: a review. II. Diagnosis and treatment.

Early diagnosis of infective endocarditis is difficult because of the insidious onset and varied clinical presentation. High degree of suspicion and blood culturing for the causative agent are essential to confirm the diagnosis. General principles of management include selection of antibiotics based on the antibiotic sensitivities of the causative organism, use of bactericidal rather than bacteriostatic drugs, usage of a combination of two or more antibiotics to enhance the synergic bactericidal activity, and their administration by the intravenous route for prolonged periods (6 weeks). Monitoring the serum bactericidal activity to confirm the biological effectiveness of the antibiotics used and adjusting the level of 1:8 to 1:16 is recommended. Specific drug therapy for each type of endocarditis is discussed. Supportive measures and indications for surgical intervention are also discussed. A summary of preventive aspects of infective endocarditis is also presented.