The Endocarditis Working Party of the British Society for Antimicrobial Chemotherapy first issued recommendations for the treatment of streptococcal and staphylococcal endocarditis in 1985.1 Since then numerous reports have been published of the results of treatment with the recommended regimens and with other antibiotics, some of which were not available in 1985, and the American Heart Association has recently reviewed its guidelines for antibiotic treatment.2 Revised diagnostic criteria3 ,4and new therapeutic procedures have also become available and many more patients have had prosthetic valves implanted. We have reviewed our recommendations in light of these developments and our wish to have simplified up to date guidelines that are most appropriate for use in the UK. They are intended to cover more than 90% of the cases of infective endocarditis seen in the UK, which are caused by streptococci, enterococci and staphylococci.

In endocarditis the heart valves may be damaged at an early stage thus prompt treatment is essential. Patients with a fever and a heart murmur should have blood cultures taken without delay before any antibiotic treatment is given. Patients with prosthetic valves who become feverish should be referred to a hospital with cardiology and, ideally, cardiothoracic surgery facilities and they should also have blood cultures taken before antibiotics are given.

A combination of a penicillin and an aminoglycoside, usually gentamicin, is still the most suitable first line treatment for streptococcal and most enterococcal and staphylococcal endocarditis. The type of penicillin, the dose, and the duration of treatment depend on the infecting organism and its in vitro antibiotic sensitivity, and this should be established as soon as possible. In patients who are allergic to penicillins one of the glycopeptide antibiotics, vancomycin or teicoplanin, should be used. We recommend similar treatment for native and prosthetic valve infections …