Evidence-based management of Infective Endocarditis according to Uganda Clinical Guidelines 2023
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features
Diagnostic triad: persistent fever, emboli, changing murmur. Fatigue, weight loss. Splinter haemorrhages, finger clubbing. Heart failure. Any unexplained fever in a patient with a heart valve problem should be regarded as endocarditis.
Investigations
Blood cultures: At least 3 sets (8 ml each) from separate venipunctures, at least 1 hour apart. Complete blood count, ESR. Urinalysis for microscopic haematuria. Echocardiography, ECG.
Treatment
Initial Empirical Therapy
Benzylpenicillin 5 MU IV every 6 hours for 4 weeks (Child: 50,000 IU/kg every 6 hours). PLUS gentamicin 1 mg/kg IV every 8 hours for 2 weeks.
If Staphylococcus suspected (acute onset)
Add Cloxacillin IV 3 g every 6 hours for 4 weeks (Child: 50 mg/kg every 6 hours).
If MRSA suspected
Vancomycin 500 mg IV every 6 hours (Child: 10 mg/kg infused over 1 hour) for 6 weeks.
Prophylaxis
For dental procedures/tonsillectomy in at-risk patients (valvular defects, prosthetic valve): Amoxicillin 2 g (50 mg/kg for children) as a single dose, 1 hour before procedure.
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