{
  "schema_version": 1,
  "kind": "condition",
  "id": "cardiovascular-infection",
  "name": "Cardiovascular infection (endocarditis / myocarditis / pericarditis)",
  "category": "chronic",
  "sources": "ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD01 - condition scope only, no dose · Infective Endocarditis - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK557641/",
  "review_status": "reviewed",
  "verified_against": "Infective Endocarditis - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK557641/",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 370,
      "generic": "Ceftriaxone",
      "line": 1,
      "is_adjunct": false,
      "form": "injection",
      "strength_mg": 2000.0,
      "adult_dose": "2 g intravenously once daily. Either 4 weeks alone, or 2 weeks with gentamicin 3 mg/kg intravenously once daily.",
      "adult_duration": "4 weeks alone, or 2 weeks in combination with gentamicin; a minimum of 6 weeks where the valve is prosthetic",
      "dose_source": "Infective Endocarditis - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK557641/",
      "rationale": "The cited article gives this regimen for native valve endocarditis caused by penicillin-susceptible viridans group streptococci or Streptococcus gallolyticus, as one of three named options: ceftriaxone 2 g intravenous daily plus gentamicin 3 mg/kg intravenous daily for 2 weeks, ceftriaxone 2 g intravenous daily for 4 weeks, or aqueous penicillin G 12 to 18 million units daily by continuous infusion. For the same organisms on a prosthetic valve it asks for a minimum of 6 weeks, of penicillin G 24 million units daily or ceftriaxone 2 g with or without gentamicin 3 mg/kg daily.",
      "cautions": [
        "THE ORGANISM CHOOSES THE DRUG, AND THIS ONE IS FOR STREPTOCOCCI. The article's regimens are organism-specific and valve-specific. The regimen given here covers penicillin-susceptible viridans group streptococci and S gallolyticus. Staphylococcal and enterococcal endocarditis are treated differently and are set out separately.",
        "THE REGIMENS HERE ARE FOR ENDOCARDITIS ONLY, THOUGH THE CARD IS NAMED FOR THREE DISEASES. The article behind it covers infective endocarditis, and the three drug options are its organism-specific endocarditis regimens. It names no treatment for myocarditis or pericarditis. Acute pericarditis has its own card, with ibuprofen, aspirin and colchicine; look it up rather than reading anything here across to it.",
        "ENTEROCOCCAL ENDOCARDITIS NEEDS TWO DRUGS AND NO AMOUNT IS PRINTED HERE. The article states that beta-lactam monotherapy is not bactericidal against enterococci, and names ampicillin or penicillin G plus an aminoglycoside such as gentamicin for 4 to 6 weeks, or ampicillin plus ceftriaxone as a dual beta-lactam alternative for Enterococcus faecalis. It gives no amounts for those, so none are written as a row.",
        "PENICILLIN G IS THE ARTICLE'S OTHER OPTION - 12 to 18 million units daily by continuous intravenous infusion on a native valve, 24 million units daily on a prosthetic one.",
        "BLOOD CULTURES EVERY 24 TO 48 HOURS. The article asks for repeat cultures at that interval to confirm the bacteraemia has cleared and to direct what follows.",
        "SOME OF THESE PATIENTS NEED SURGERY WITHIN 48 HOURS, NOT MORE ANTIBIOTIC. The article's emergent indications include acute heart failure, heart block or an aortic or annular abscess, systemic embolisation or a vegetation over 10 mm, cerebrovascular complications, bacteraemia persisting beyond 5 to 7 days on appropriate treatment, and most early prosthetic valve infections.",
        "Do not give in hypersensitivity to ceftriaxone, any component, or another cephalosporin."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "The article gives no paediatric endocarditis regimen, so none is printed. The Egyptian formulary's ceftriaxone monograph says only that higher doses are used in endocarditis and caps a child at 4 g daily there, without stating the milligram-per-kilogram figure. A child with endocarditis is dosed by the admitting team.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "ZOXIDEL 2 GM PD. FOR I.V. INJ.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "RAMEDA > DELTA PHARMA",
          "price_egp": 33.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 2000.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "EPICEPHIN 2 GM I.V. VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO",
          "price_egp": 77.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 2000.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "XORAXON 2 GM I.V. VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MUP",
          "price_egp": 83.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 2000.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "CEFAXONE 2 GM I.V. VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "PHARCO B",
          "price_egp": 96.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 2000.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "cardiovascular-infection"
    },
    {
      "id": 371,
      "generic": "Cefazolin",
      "line": 1,
      "is_adjunct": false,
      "form": "injection",
      "strength_mg": 1000.0,
      "adult_dose": "2 g intravenously every 8 hours.",
      "adult_duration": "6 weeks",
      "dose_source": "Infective Endocarditis - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK557641/",
      "rationale": "The cited article gives two options for native valve endocarditis caused by methicillin-sensitive Staphylococcus aureus: nafcillin 2 g intravenous every 4 hours for 6 weeks, or cefazolin 2 g intravenous every 8 hours for 6 weeks. Cefazolin is offered because nafcillin is not registered in Egypt and cefazolin is. The Egyptian supply is thin: the register holds three ZINOL entries, one of them withdrawn, and only the 1 g vial matches a 2 g eight-hourly regimen - two vials per dose.",
      "cautions": [
        "THIS IS THE METHICILLIN-SENSITIVE REGIMEN. If the organism is methicillin-resistant, the article's drug is vancomycin rather than cefazolin, on its own regimen.",
        "DO NOT ADD GENTAMICIN TO IT ON A NATIVE VALVE. The article states that gentamicin dual therapy is no longer recommended for either MSSA or MRSA native valve infection, for lack of benefit and concern about nephrotoxicity.",
        "A PROSTHETIC VALVE IS A DIFFERENT REGIMEN. There the article asks for combination therapy: the antistaphylococcal drug for 6 weeks, gentamicin 3 mg/kg intravenously in 2 to 3 divided doses for 2 weeks, and rifampicin 900 mg/day intravenously in 2 to 3 divided doses for 6 weeks.",
        "Do not give in hypersensitivity to cefazolin, any component, or another cephalosporin."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "The article gives no paediatric endocarditis regimen, so none is printed.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "ZINOL 1 GM I.M./I.V. VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "PHARCO B",
          "price_egp": 48.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 1000.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "cardiovascular-infection"
    },
    {
      "id": 372,
      "generic": "Vancomycin",
      "line": 1,
      "is_adjunct": false,
      "form": "injection",
      "strength_mg": 500.0,
      "adult_dose": "15 mg/kg intravenously every 12 hours.",
      "adult_duration": "6 weeks",
      "dose_source": "Infective Endocarditis - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK557641/",
      "rationale": "The cited article gives two options for native valve endocarditis caused by methicillin-resistant Staphylococcus aureus: vancomycin 15 mg/kg intravenous every 12 hours for 6 weeks, or daptomycin 8 mg/kg intravenous daily for 6 weeks. Vancomycin leads because Egypt registers seventeen vancomycin products and one daptomycin vial.",
      "cautions": [
        "THE DOSE IS A STARTING POINT AND THEN THE LEVELS DECIDE. The Egyptian formulary asks for initial vancomycin dosing on actual body weight and for every subsequent dose to be set by therapeutic drug monitoring, and for levels to be watched in any degree of renal impairment.",
        "DO NOT ADD GENTAMICIN TO IT ON A NATIVE VALVE. The article states that gentamicin dual therapy is no longer recommended for MSSA or MRSA native valve infection, for lack of benefit and concern about nephrotoxicity.",
        "A PROSTHETIC VALVE IS A DIFFERENT REGIMEN - vancomycin for 6 weeks with gentamicin 3 mg/kg intravenously in 2 to 3 divided doses for 2 weeks and rifampicin 900 mg/day intravenously in 2 to 3 divided doses for 6 weeks.",
        "DAPTOMYCIN IS THE ARTICLE'S ALTERNATIVE at 8 mg/kg intravenously daily for 6 weeks, and Egypt registers one product. It is also what the article reaches for, with linezolid, where resistance to penicillin, gentamicin and vancomycin is emerging.",
        "Do not give in hypersensitivity to vancomycin or any component of the formulation."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "The article gives no paediatric endocarditis regimen, so none is printed.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "KEMPOVANCOM 500 MG VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "KAHIRA > MODERN OFFICE FOR IMPORT",
          "price_egp": 18.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "VANCOZIN 500 MG VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIMC > KOREA UNITED PHARMA",
          "price_egp": 38.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "VANCOMIX 500MG I.V. VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SIGMA TEC",
          "price_egp": 79.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "VANCOGUT 500 MG PD. FOR I.V. INF. VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ARABCOMED",
          "price_egp": 95.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "VANCOLON 500MG I.V. VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "JULPHAR",
          "price_egp": 95.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "EDICIN 500 MG PD FOR I.V. INF. VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "GLOBAL PHARMACEUTICAL INDUSTRIES",
          "price_egp": 118.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "VANCOBACT 500 MG VIAL FOR I.V. INF.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ARABCOMED > EGYPHARMA",
          "price_egp": 118.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "VANCOMYCINE VIATRIS 500 MG VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "VIANAX - GREECE > ONE PHARMA MEDICS",
          "price_egp": 142.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "cardiovascular-infection"
    },
    {
      "id": 373,
      "generic": "Referral & safety-netting (no drug therapy)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": "Covers endocarditis, myocarditis, and pericarditis, all of which need urgent hospital referral for cultures, imaging, and intravenous therapy; the GP's role is recognition and same-day referral. Pericarditic chest pain is treated on the acute pericarditis card, which carries the anti-inflammatory regimen; no analgesic is dosed here.",
      "adult_duration": "Refer, with advice",
      "dose_source": "No dose - referral pathway, no medicine given in primary care",
      "rationale": "Covers endocarditis, myocarditis, and pericarditis, all of which need urgent hospital referral for cultures, imaging, and intravenous therapy; the GP's role is recognition and same-day referral. Pericarditic chest pain is treated on the acute pericarditis card, which carries the anti-inflammatory regimen; no analgesic is dosed here.",
      "cautions": [
        "Fever with a new heart murmur, breathlessness, chest pain, or embolic signs (stroke, painful fingers or toes) must be treated as a medical emergency.",
        "The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "cardiovascular-infection"
    }
  ]
}