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Infective Endocarditis — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesInfective EndocarditisRACP Adult Medicine

A 45-year-old man presents with fever, new cardiac murmur, splinter haemorrhages, and Janeway lesions. He has a history of IV drug use. Blood cultures grow methicillin-sensitive Staphylococcus aureus. Transoesophageal echocardiogram shows a 15 mm vegetation on the tricuspid valve. What is the most appropriate antibiotic regimen?

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Correct answer: B — Flucloxacillin IV for 4–6 weeks

MSSA tricuspid valve endocarditis in IV drug users is treated with IV flucloxacillin (or cefazolin as an equal alternative per eTG 2025 update) for 4–6 weeks. Gentamicin is no longer routinely added for native valve staphylococcal endocarditis. Vancomycin is reserved for MRSA or severe penicillin allergy.

Reference: eTG Antibiotic – 2025 – Endocarditis; ESC 2023 IE Guidelines