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Abstract：
Infective endocarditis is one of the most difficult-to-treat infectious diseases.
We restricted this review to the anti-infective treatment of the main bacteria responsible for infective endocarditis, i.e. staphylococci, streptococci, enterococci, and Gram-negative bacilli, including HACEK. Specific topics of major interest in treatment strategy are covered as well, including empirical treatment, oral switch, and treatment duration. We searched in the MEDLINE database to identify relevant studies, trials, reviews, or meta-analyses until May 2020.
The use of aminoglycosides for the treatment of endocarditis has been dramatically reduced over the last 20 years. It should be administered once daily, and no longer than 2 weeks. For staphylococcal endocarditis, recent data reinforced the role of anti-staphylococcal penicillins, for methicillin-susceptible isolates (alternative, cefazolin), and vancomycin for methicillin-resistant isolates (alternative, daptomycin). For staphylococcal prosthetic-valve endocarditis, these treatments will be reinforced by the addition of gentamicin during the first 2 weeks, and rifampin throughout the whole treatment duration, i.e. 6 weeks. The optimal duration of antibacterial treatment is 4 weeks for most native valve endocarditis, and 6 weeks for prosthetic-valve endocarditis. The oral switch is safe in patients stabilized after the initial intravenous course.
We restricted this review to the anti-infective treatment of the main bacteria responsible for infective endocarditis, i.e. staphylococci, streptococci, enterococci, and Gram-negative bacilli, including HACEK. Specific topics of major interest in treatment strategy are covered as well, including empirical treatment, oral switch, and treatment duration. We searched in the MEDLINE database to identify relevant studies, trials, reviews, or meta-analyses until May 2020.
The use of aminoglycosides for the treatment of endocarditis has been dramatically reduced over the last 20 years. It should be administered once daily, and no longer than 2 weeks. For staphylococcal endocarditis, recent data reinforced the role of anti-staphylococcal penicillins, for methicillin-susceptible isolates (alternative, cefazolin), and vancomycin for methicillin-resistant isolates (alternative, daptomycin). For staphylococcal prosthetic-valve endocarditis, these treatments will be reinforced by the addition of gentamicin during the first 2 weeks, and rifampin throughout the whole treatment duration, i.e. 6 weeks. The optimal duration of antibacterial treatment is 4 weeks for most native valve endocarditis, and 6 weeks for prosthetic-valve endocarditis. The oral switch is safe in patients stabilized after the initial intravenous course.
摘要：
感染性心内膜炎是最难以治疗的感染性疾病之一。
我们将这篇综述限制在感染性心内膜炎的主要细菌的抗感染治疗上，即葡萄球菌,链球菌,肠球菌,和革兰氏阴性杆菌,包括HACEK.还涵盖了治疗策略中主要感兴趣的特定主题，包括经验治疗，口腔开关，和治疗持续时间。我们在MEDLINE数据库中搜索了相关研究，试验,reviews,或荟萃分析，直到2020年5月。
在过去的20年中，氨基糖苷类用于治疗心内膜炎的应用已显著减少。它应该每天给药一次，不超过2周。对于葡萄球菌心内膜炎，最近的数据加强了抗葡萄球菌青霉素的作用，对于甲氧西林敏感的分离株(替代方案，头孢唑啉)，和万古霉素用于耐甲氧西林分离株(替代方案，达托霉素）。对于葡萄球菌性人工瓣膜心内膜炎，这些治疗将通过在前2周内添加庆大霉素来加强，和利福平在整个治疗期间，即6周。对于大多数天然瓣膜心内膜炎，抗菌治疗的最佳持续时间是4周。人工瓣膜心内膜炎6周。在最初的静脉疗程后稳定的患者中，口服开关是安全的。
我们将这篇综述限制在感染性心内膜炎的主要细菌的抗感染治疗上，即葡萄球菌,链球菌,肠球菌,和革兰氏阴性杆菌,包括HACEK.还涵盖了治疗策略中主要感兴趣的特定主题，包括经验治疗，口腔开关，和治疗持续时间。我们在MEDLINE数据库中搜索了相关研究，试验,reviews,或荟萃分析，直到2020年5月。
在过去的20年中，氨基糖苷类用于治疗心内膜炎的应用已显著减少。它应该每天给药一次，不超过2周。对于葡萄球菌心内膜炎，最近的数据加强了抗葡萄球菌青霉素的作用，对于甲氧西林敏感的分离株(替代方案，头孢唑啉)，和万古霉素用于耐甲氧西林分离株(替代方案，达托霉素）。对于葡萄球菌性人工瓣膜心内膜炎，这些治疗将通过在前2周内添加庆大霉素来加强，和利福平在整个治疗期间，即6周。对于大多数天然瓣膜心内膜炎，抗菌治疗的最佳持续时间是4周。人工瓣膜心内膜炎6周。在最初的静脉疗程后稳定的患者中，口服开关是安全的。
