skip to main content

IE Antibiotic Duration — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateValvular Heart DiseaseIE Antibiotic DurationEECC

A 58-year-old man with active IE caused by Enterococcus faecalis involving the native aortic valve has a 10 mm vegetation with mild AR. He responds well to 2 weeks of ampicillin plus gentamicin. No embolic events have occurred. What is the recommended total duration of antibiotic therapy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — At least 6 weeks of appropriate intravenous antibiotic therapy for native valve endocarditis

The 2023 ESC IE Guidelines recommend at least 4-6 weeks of IV antibiotic therapy for native valve IE. For Enterococcus faecalis specifically, treatment requires synergistic combination therapy: ampicillin plus gentamicin (4-6 weeks) or ampicillin plus ceftriaxone (6 weeks, preferred for gentamicin-intolerant patients or those with renal impairment — the POET trial did not include enterococcal IE). The POET trial demonstrated that in selected stable patients with left-sided IE (certain organisms, no abscess, adequate response), partial oral switch after ≥10 days IV may be considered — but this was for streptococci, staphylococci, and E. faecalis. For enterococci, the evidence for oral switch is more limited. Treatment duration is counted from the first day of effective therapy.

Reference: ESC (2023): Guidelines on Infective Endocarditis