Mild congestive heart failure resulting from valvular insufficiency or myocarditis may be managed with standard medical therapy.
A combination of an inhibitor of cell wall synthesis (ie, penicillin, vancomycin) with an aminoglycoside (ie, gentamicin, streptomycin) is necessary to achieve bactericidal activity against the enterococci.
Tobramycin or amikacin does not act synergistically with antibiotics active against the bacterial cell wall.
Some of the effects of IE require surgical intervention.
Emergent care should focus on making the correct diagnosis and stabilizing the patient with acute disease and cardiovascular instability.
Alternative choices are imipenem, ciprofloxacin, or ampicillin with sulbactam.
Vancomycin does not appear to be as useful as the aforementioned antibiotics.Native valve endocarditis (NVE) has often been treated with penicillin G and gentamicin for synergistic coverage of streptococci.Patients with a history of intravenous (IV) drug use have been treated with nafcillin and gentamicin to cover for methicillin-sensitive staphylococci.Double beta-lactam therapy (ampicillin 2 g IV every 4 hours and ceftriaxone 2 g IV every 12 hours) is recommended for treatment of enterococci susceptible to penicillin and gentamicin when the creatinine clearance is less than 50 m L/min.This combination may be effective against enterococcal isolates that are resistant to high doses of gentamicin.Organisms with a minimum inhibitory concentration (MIC) to vancomycin of equal to or greater than 2 mcg/m L should be treated with alternative agents.