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However, it should be administered with vancomycin or gentamicin.These latter 2 agents serve to prevent the development of resistance to the rifampin.General measures include the following: In most cases, the etiologic microbial agent is not known while the patient is in the ED.Three sets of blood cultures should be drawn over a few hours, and then empiric antibiotic therapy tailored to the patient’s history and circumstances may be administered (see Antibiotic Therapy, below).No special diets are recommended for patients with endocarditis; however, if the patient has congestive heart failure, administer a sodium-restricted diet.Activity limitations are determined by the severity of the illness, complications (eg, stroke), and the presence of significant congestive heart failure.In the setting of acute IE, institute antibiotic therapy as soon as possible to minimize valvular damage.
Vancomycin does not appear to be as useful as the aforementioned antibiotics.
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.
The major goals of therapy for infective endocarditis (IE) are to eradicate the infectious agent from the thrombus and to address the complications of valvular infection.
The latter includes both the intracardiac and extracardiac consequences of IE.
Of gentamicin-resistant enterococcal strains, 25% are susceptible to streptomycin.