Patient handout

Infective endocarditis (Duke-ISCVID)

PRODUCTION

1. Your condition

This handout is for infective endocarditis (duke-iscvid). Your care team identified this based on: fever + new murmur / vegetation (acc/aha 2022).

Other reasons your team may use this plan: persistent bacteremia (≥2 sets, typical organism) (acc/aha 2022); embolic stroke, septic emboli, janeway / osler / roth (acc/aha 2022); tte/tee vegetation, abscess, prosthetic dehiscence (acc/aha 2022).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
vancomycin	25–30 mg/kg load IV → 15–20 mg/kg q8–12h targeting AUC24 400–600	IV	q8–12h	Covers MRSA + Streptococci; AUC-guided dosing (ACC/AHA 2022)
ceftriaxone	2 g IV q24h	IV	q24h	Covers Streptococci, HACEK (ACC/AHA 2022)
ampicillin	2 g IV q4h	IV	q4h	Covers Enterococci (ACC/AHA 2022)
gentamicin	3 mg/kg/d IV (divided q8h or once daily) — synergy	IV	q8h	AHA 2015 — no longer routine for native S. aureus IE

Plan: IE pathogen-directed antibiotics + surgical decision (2023 AHA/ACC + ESC)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

≥1 of: HF from valve destruction / uncontrolled infection / abscess / persistent bacteremia >5 d / vegetation >10 mm + embolic / prosthetic / perivalvular extension (ACC/AHA 2022)
CIED system infection (pocket, lead, valve) (ACC/AHA 2022)
BCs positive >5 d on appropriate abx (ACC/AHA 2022)
Vegetation >10 mm + ≥1 embolic event OR vegetation >15 mm (ACC/AHA 2022)
IE complicated by septic shock (ACC/AHA 2022)(life-threatening)
Acute stroke as IE complication (ACC/AHA 2022)(life-threatening)

5. Follow-up

Post-treatment echo; dental clearance; long-term IE prophylaxis per AHA/ESC indications

6. Sources

Guideline: 2023 AHA/ACC IE focused update + ESC 2023 IE Guidelines + Duke-ISCVID 2023 + POET (NEJM 2019)