Treatment

Goals of therapy:

1. Antimicrobial therapy:
   The most common bacteria are Staphylococci, Streptococci, and E. coli. Bartonella spp. have been identified in culture negative cass. Therapy should be based on culture and susceptibility where possible. The empiric antibiotics of choice for broad-spectrum coverage are penicillins or cephalosporins combined with fluoroquinolones or aminoglycosides for 5-6 weeks.
2. Provide fluid and caloric support where appropriate.
3. Treat heart failure if it develops.

Comment: A high serum concentration of antibiotic and prolonged duration of therapy are necessary because of the difficulty in reaching bacteria within the vegetative lesion of platelets and fibrin. Bactericidal antibiotics are indicated because the host’s phagocytic cells cannot always reach the infective organisms.