Current antibiotic guidelines (source: British National Formulary)

If penicillin allergic, MRSA or severe sepsis • vancomycin + low-dose gentamicin

If prosthetic valve • vancomycin + rifampicin + low-dose gentamicin | | Native valve endocarditis caused by staphylococci | Flucloxacillin

If penicillin allergic or MRSA • vancomycin + rifampicin | | Prosthetic valve endocarditis caused by staphylococci | Flucloxacillin + rifampicin + low-dose gentamicin

If penicillin allergic or MRSA • vancomycin + rifampicin + low-dose gentamicin | | Endocarditis caused by fully-sensitive streptococci (e.g. viridans) | Benzylpenicillin

If penicillin allergic • vancomycin + low-dose gentamicin | | Endocarditis caused by less sensitive streptococci | Benzylpenicillin + low-dose gentamicin

If penicillin allergic • vancomycin + low-dose gentamicin |

Indications for surgery

• severe valvular incompetence
• aortic abscess (often indicated by a lengthening PR interval) or fistula
• infections resistant to antibiotics/fungal infections
• persistent bacteraemia despite adequate antibiotics
• CHF from valve dysfunction
• recurrent emboli after antibiotic therapy
• large vegetations

Prophylaxis (high yield)

Reserved for high-risk cardiac lesions + high-bacteraemia procedures (mainly certain dental work).