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Infective Endocarditis — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionInfective EndocarditisSCE Infectious Diseases

A 55-year-old man presents with a 6-week history of malaise, weight loss, and a new cardiac murmur. Blood cultures (3 sets) grow Enterococcus faecalis. TOE confirms a 10 mm vegetation on the mitral valve with moderate mitral regurgitation. Sensitivities show the organism is susceptible to Ampicillin and Gentamicin (no high-level aminoglycoside resistance). What is the preferred treatment regimen?

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Correct answer: E — Ampicillin IV plus Gentamicin IV for 4–6 weeks

Enterococcal endocarditis susceptible to Ampicillin and without high-level aminoglycoside resistance (HLAR) is treated with Ampicillin plus Gentamicin for 4–6 weeks. The combination is synergistically bactericidal. If HLAR is present, the alternative is Ampicillin plus Ceftriaxone (double beta-lactam) for 6 weeks, which avoids aminoglycoside toxicity. Vancomycin is reserved for true beta-lactam allergy. Ampicillin monotherapy is insufficient for enterococcal endocarditis.

Reference: ESC 2023 – Guidelines for management of endocarditis; BSAC 2012 – Endocarditis treatment