What is the empirical therapy for prosthetic valve endocarditis?

Ampicillin, vancomycin, and gentamicin.

1Name four peripheral stigmata of IE.

Janeway lesions

Roth’s spots

Splinter hemorrhages

Osier’s nodes

What is Osier’s or Austrian triad?

Osier’s or Austrian triad consists of endocarditis, pneumonia, and meningitis. The most common organism is Streptococcus pneumoniae, which is especially prevalent in alcoholic (40%), elderly, and diabetic patients. The course is fulminant, with rapid valve destruction and abscess formation. The aortic valve is most often involved, followed by the tricuspid valve. Infection is usually responsive to penicillin, but resistant strains that require vancomycin are becoming more common.

Aortic valve endocarditis.

Is anticoagulation helpful in the management of IE?

Although the vegetation is basically a thrombotic lesion and may embolize, no evidence suggests that anticoagulation is helpful in reducing embolization or preventing growth of vegetation. In fact, negative results, including increased rates of fatal intracerebral hemorrhage from mycotic aneurysms, cerebral embolus, and infarction, have been associated with use of heparin. However, recent data show that use of warfarin with antibiotic therapy is safe in patients with prosthetic valve IE. The suggested protocol is to avoid heparin entirely unless there is a major indication (e.g., massive pulmonary embolism) and to use warfarin anticoagulation as necessary at the low range (international normalized ratio 2.5-3.5).

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