Treatment Overview

There are three main goals when treating endocarditis:

• Quickly destroy the infection.
• Repair or replace a heart valve, if needed.
• Treat complications.

Destroy the infection

If you have endocarditis, you will need several weeks of treatment with one or more antibiotics. At first you will be treated in the hospital, because the antibiotics are given through a vein (by IV) and you may need other tests during treatment. After your fever is gone and you are stable, you may be able to continue IV antibiotics at home with the help of a home health nurse.

Antibiotics are usually given for 4 to 8 weeks, but some people may require only 2 to 4 weeks of treatment. How long you take antibiotics may depend on what type of bacteria is causing the infection or whether you have an infection of artificial heart valves. For example, you may take antibiotics for a longer time because you have artificial heart valves. The antibiotics must be given long enough and at a strong enough dose to destroy all of the bacteria.

After the first IV antibiotics, your doctor may want you to take antibiotic pills. If so, take them exactly as prescribed until they are gone. If your symptoms return, call your doctor right away. You probably will need more antibiotics if testing shows that the bacteria were not completely destroyed.

If endocarditis is caused by a fungus, you may need intravenous antifungal medicine. And heart valve surgery usually is required for endocarditis caused by a fungus.

Surgery

If your heart valve becomes severely damaged from endocarditis or if infection develops in an artificial heart valve, you may need surgery to repair or replace the valve.

You may need surgery if you have:

• Heart failure.
• A fungal infection.
• An abscess in your heart.
• Damage to the electrical system of your heart.
• Infected tissue that repeatedly breaks off the valve and travels to other parts of your body (for example, lungs, brain, or kidneys).

Your medical team

Treatment for endocarditis is usually guided by an infectious disease specialist. A cardiologist may also be involved if your heart muscle or valves are damaged. You will need a cardiovascular surgeon if you have heart valve replacement surgery.