Gram-positive infective endocarditis

Infective involvement of the endocardium, usually heart valves, most often caused by Staphylococcus aureus, viridans streptococci, or enterococci. Gentamicin is used in combination with a beta-lactam or vancomycin for synergy under narrow regimens described in AHA 2015 and ESC 2023.

ICD-10 I33.01 drug

Also known as: Native valve IE, Enterococcal endocarditis

Drugs used for this condition

BGentamicinAdd-on therapy · Aminoglycoside antibioticIn gram-positive infective endocarditis (staphylococcal, streptococcal), gentamicin is not the backbone but a short synergistic add-on to a beta-lactam or vancomycin in selected situations, such as the early phase of prosthetic-valve disease. The 2023 ESC guidelines cut back routine gentamicin because of nephrotoxicity: in most regimens it does not improve outcomes and is not recommended. The backbone is a beta-lactam or vancomycin, with gentamicin kept as a reserve component under renal-function monitoring. For Enterococcus faecalis endocarditis the role differs, where ampicillin plus gentamicin is part of first-line therapy.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit