Besnier J M, Choutet P
Service de maladies infectieuses Hôpital Bretonneau, Tours.
Rev Prat. 1998 Mar 1;48(5):513-8.
Antibiotic treatment of infective endocarditis has to be discussed when the microorganism has been identified. Antibiotics must be started as soon as possible, just after blood samplings in case of clinical bacteraemia, or as soon as blood cultures are positive. In case of negative blood cultures, diagnosis of endocarditis has to be reconsidered, according to Duke's criteria, and antibiotics must not be started until there is strong evidence in favour of infective endocarditis. Antibiotic treatment must be bactericidal, intravenously administered, for a long time to sterilize vegetations. Duration of antibiotics depends on the microorganism, and whether there is a valvular prosthesis or not. Hospitalization is often mandatory, but there is a trend towards the use of outpatient treatments, only possible in some indications.
当已鉴定出微生物时,必须讨论感染性心内膜炎的抗生素治疗。一旦确定临床菌血症,在采集血样后应尽快开始使用抗生素,或者一旦血培养呈阳性就应立即开始。如果血培养结果为阴性,必须根据杜克标准重新考虑心内膜炎的诊断,在有强有力证据支持感染性心内膜炎之前不得开始使用抗生素。抗生素治疗必须具有杀菌作用,通过静脉给药,且持续较长时间以使赘生物无菌化。抗生素的使用时长取决于微生物种类以及是否存在人工瓣膜。通常需要住院治疗,但目前有采用门诊治疗的趋势,不过仅在某些适应症情况下可行。