24th July 2020

Mrs Jones presents to A&E with shortness of breath which developed over the last two weeks and gets worse on exertion

Mrs Jones presents to A&E with shortness of breath which developed over the last two weeks and gets worse on exertion. She has been waking up at night out of breath and has noticed that her ankles have become swollen. She has not been feeling well before these last two weeks, having had dysuria and increasing urinary frequency. She had been treated by her GP for recurrent urinary tract infections. You can see from her notes that she was last admitted to hospital five years ago for a mitral valve repair.  On examination, you note the peripheral oedema and hear a previously undocumented pansystolic murmur. Her observations are as follows: 

HR 98, BP 140/98, RR 19, SpO2 95% on air, Temp 39.1oC

A diagnosis of infective endocarditis is made. 

Select the SINGLE most appropriate treatment option from the list below. Select ONE option only.