# Cardiovascular infection (endocarditis / myocarditis / pericarditis) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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/ - Verified date: 2026-08 ## Verified against - Infective Endocarditis - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK557641/ ## Treatment metadata - Ceftriaxone — 2000 mg — injection - Cefazolin — 1000 mg — injection - Vancomycin — 500 mg — injection - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text CARDIOVASCULAR INFECTION (ENDOCARDITIS / MYOCARDITIS / PERICARDITIS) 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 against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - Suspect it in anyone at risk who has fever or sepsis with no obvious source [fever · sepsis] - Creeping onset of fever, chills, malaise and tiredness, usually bringing the patient in within a month [chills · fatigue · fever · malaise] - Temperature above 38 C in more than 95 of every 100 cases [fever] - Fever can be missing or muted in the immunosuppressed, the elderly, and after antipyretics or antibiotics [fever] - Poor appetite, headache and general weakness are common [headache · poor appetite] - Chest pain, breathlessness, poor exercise tolerance, orthopnoea or night attacks point to a damaged valve [breathlessness · chest pain · orthopnoea] - A valve that fails suddenly presents as abrupt heart failure with unstable circulation - Ask about lines, injected drugs, rheumatic heart disease, a recent pacemaker, prosthetic valves and congenital defects - Worn valves such as calcified aortic stenosis or mitral prolapse lie behind roughly 30 in 100 cases [stricture] SIGNS - what you find (9) - Fever is usual; fast breathing and fast pulse may go with it [fever · tachypnoea] - Low blood pressure from septic or cardiogenic shock, above all when a valve has perforated [hypotension · sepsis · shock] - A new or louder murmur is found in fewer than half, but it locates the affected valve [heart murmur] - Crackles in both lung bases with severe mitral or aortic regurgitation [crackles] - Osler nodes: tender red lumps under the skin of palm, fingers and toes - Janeway lesions: painless bleeding-looking patches on palms and soles, plus splinter haemorrhages [bleeding] - Each of these skin signs appears in fewer than one patient in ten - An enlarged spleen, or peritonitis from gut ischaemia [ischaemia · splenomegaly] - Focal weakness, numbness or visual change points to clot thrown to the brain [numbness] TESTS (12) - Blood count often shows a high white count; longer-standing cases show anaemia of chronic disease - ESR and CRP are raised in about 60 of every 100 cases, but prove nothing on their own - Urine may show protein, unseen blood or pus cells from kidney injury or infarction - Diagnosis rests on the germ grown and what the echo shows - Two separate cultures positive for viridans streptococci, S gallolyticus, HACEK, S aureus or community enterococci with no other source - For unusual germs, bacteraemia must persist: two cultures over 12 hours apart, or most of at least four - Echo evidence means a mobile mass on a valve, its supports, or prosthetic material - Lung disease, past chest surgery, obesity and prosthetic valves blur the transthoracic view, so go early to transoesophageal - Cardiac CT beats transoesophageal echo for an abscess beside the valve, 88 against 74 in 100 - ECG is often normal, but ST elevation is treated as a myocardial infarction whatever else is going on - Chest film may show lung shadowing, abscess or fluid, and with a leaking left-sided valve, oedema and a big heart - New focal neurological signs need urgent brain imaging and a neurology opinion IF NOT THIS - what else fits (6) - With chest pain: aortic dissection, myopericarditis, acute heart failure or acute coronary syndrome - Also lung clot, pneumonia or empyema - With a prosthetic valve: clot around the valve, especially if anticoagulation lapsed, or sutures giving way - Repeated arterial emboli soon after a heart attack suggest clot lining the ventricle - A new murmur in a well young adult raises atrial myxoma - Sterile valve clot: marantic endocarditis with cancer, or Libman-Sacks with lupus Source StatPearls "Infective Endocarditis" - disease-level clinical article Status traced to the source above Rx: Streptococcal endocarditis | Staphylococcal endocarditis - methicillin-sensitive | Staphylococcal endocarditis - methicillin-resistant | Main treatment STREPTOCOCCAL ENDOCARDITIS 1. CEFTRIAXONE [1st line] Adult 2 g intravenously once daily. Either 4 weeks alone, or 2 weeks with gentamicin 3 mg/kg intravenously once daily. x 4 weeks alone, or 2 weeks in combination with gentamicin; a minimum of 6 weeks where the valve is prosthetic Peds 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. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Infective Endocarditis - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK557641/ Why 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. Caution 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. Egypt ZOXIDEL 2 GM PD. FOR I.V. INJ. RAMEDA > DELT... 33.00 EGP EPICEPHIN 2 GM I.V. VIAL EIPICO 77.00 EGP XORAXON 2 GM I.V. VIAL MUP 83.00 EGP CEFAXONE 2 GM I.V. VIAL PHARCO B 96.00 EGP STAPHYLOCOCCAL ENDOCARDITIS - METHICILLIN-SENSITIVE 2. CEFAZOLIN [1st line] Adult 2 g intravenously every 8 hours. x 6 weeks Peds The article gives no paediatric endocarditis regimen, so none is printed. Source Infective Endocarditis - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK557641/ Why 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. Caution 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. Egypt ZINOL 1 GM I.M./I.V. VIAL PHARCO B 48.00 EGP STAPHYLOCOCCAL ENDOCARDITIS - METHICILLIN-RESISTANT 3. VANCOMYCIN [1st line] Adult 15 mg/kg intravenously every 12 hours. x 6 weeks Peds The article gives no paediatric endocarditis regimen, so none is printed. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Infective Endocarditis - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK557641/ Why 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. Caution 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. Egypt KEMPOVANCOM 500 MG VIAL KAHIRA > MODE... 18.00 EGP VANCOZIN 500 MG VIAL EIMC > KOREA ... 38.00 EGP VANCOMIX 500MG I.V. VIAL SIGMA TEC 79.00 EGP VANCOGUT 500 MG PD. FOR I.V. INF. VIAL ARABCOMED 95.00 EGP VANCOLON 500MG I.V. VIAL JULPHAR 95.50 EGP EDICIN 500 MG PD FOR I.V. INF. VIAL GLOBAL PHARMACEUTICAL INDUSTRIES 118.00 EGP VANCOBACT 500 MG VIAL FOR I.V. INF. ARABCOMED > EGYPHARMA 118.00 EGP VANCOMYCINE VIATRIS 500 MG VIAL VIANAX - GREE... 142.00 EGP MAIN TREATMENT 4. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why 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. Caution 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. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)