ABSTRACT
There has been no other bacterial infection, with the exception of bacterial meningitis, whose clinical course has been so favorably altered by the availability of antimicrobial agents than that of infective endocarditis (IE). This disease was always fatal, although the patient could live well beyond a year with untreated subacute IE, (1). Antistreptococcal vaccines and various types of dyes (gentian violet) were unsuccessfully employed. The availability of the first sulfonamide, sulfanilamide, in 1936 marked the beginning of the modern antimicrobial era. Although it had impressive results against many types of infections, it had little effect on IE. By administering penicillin, the physician, who used to be a mere observer of the inevitable, was able to cure 90% of cases of streptococcal IE. This chapter focuses both on the principles and specifics of the antibiotic management of the various types of IE. The therapeutic precepts of antibiotic management of IE have been slowly, and sometimes painfully, accrued over the decades. The rules are constantly evolving with the availability of newer types of intravascular and intracardiac devices, more potent immunosuppressive agents, and newer classes of antibiotics.
