This protocol applies to right-sided infective endocarditis caused by methicillin-susceptible Staphylococcus aureus (MSSA) in people who inject drugs (PWID), where the clinical presentation meets a defined set of low-risk criteria that may permit an abbreviated treatment course.
Right-sided infective endocarditis in a person who injects drugs, with confirmed methicillin-susceptible Staphylococcus aureus; vegetation size ≤20 mm; and absence of metastatic sites of infection, empyema, cardiac or extracardiac complications, prosthetic or left-sided valve involvement, and severe immunosuppression.
The protocol defines a two-week antibiotic regimen centred on an anti-staphylococcal penicillin, given without aminoglycoside combination. For cases where the standard intravenous route is not feasible, a specific oral combination regimen is outlined — applicable only when strict eligibility criteria are met and patient adherence can be closely monitored.
DOI: 10.1093/eurheartj/ehad193
Two-week treatment with oxacillin (or cloxacillin) without gentamicin is effective when: the vegetation size is ≤20 mm; and the case is uncomplicated in a person who injects drugs.
When the conventional i.v. route therapy is not possible, S. aureus right-sided IE in PWID may also be treated with oral ciprofloxacin (750 mg twice a day) plus rifampin (300 mg twice a day) if the strain is susceptible to both drugs, the case is uncomplicated, and patient adherence is monitored carefully.
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