24th June 2026

Medical Management

The mainstay of medical management of IE is antimicrobial therapy, as well as other supportive measures.

Antimicrobial therapy

Antibiotic therapy should be targeted based on the microorganism isolated from the blood cultures.  If patients are acutely unwell, empirical antibiotics should be commenced, however, this should be after at least two (preferably three) sets of blood cultures have been taken. The appropriate empirical antibiotic regimen depends on whether the valve in native or prosthetic, and depends on the likely causative microorganism, as summarised in Table 3.

Duration of therapy in NVIE is generally four to six weeks, whilst in PVIE the duration is usually a minimum of six weeks, and additional surgical management is often required.

Table 3: recommended empirical antibiotics in infective endocarditis

Antimicrobial prophylaxis

Antibiotic prophylaxis is no longer recommended routinely for patients undergoing dental procedures, or for patients undergoing procedures involving the GI tract, genitourinary tract (including gynaecological and obstetric procedures), or the upper and lower respiratory tracts. However, for patients deemed to be at the highest risk for developing IE, antibiotics prophylaxis may be considered for dental procedures, procedures involving the respiratory tract, procedures involving skin and soft tissues, and cardiac surgery involving implantation of prosthetic material. The table below summaries those patients who would be deemed to be at the highest risk of developing IE.

Patients considered to be at high risk are those with the following conditions:

• acquired valve disease (stenosis or regurgitation);
• hypertrophic cardiomyopathy;
• previous IE,
• structural congenital heart disease (excluding isolated ASD, fully repaired VSD or PDA, and closure devices that are fully incorporated into the endothelium)
• patients with a prosthetic valve.

Antithrombotic therapy

Patients are at high risk of thrombotic events from septic emboli, and subsequently high risk for bleeding (including intracerebral haemorrhage), and therefore routine anti-platelet and anticoagulant therapy is not advised in patients with IE, and has not been shown to reduce the risk of embolic complications.