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The acutely ill patient

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Seek expert advice.

Antibiotics are given according to the organism most likely involved. Current UK guidelines recommend i.v. benzylpenicillin plus i.v. gentamicin as initial empirical treatment unless staphylococcal endocarditis is suspected when vacomycin is substituted for penicillin (1). If a patient is penicillin allergic then empirical treatment should be with vancomycin plus gentamicin (1).

Sit the patient up and administer oxygen and diamorphine - initially at a low dose. This acts as a vasodilator and reduces panic.

Consider a diuretic - for example frusemide 40mg iv, which also acts as a vasodilator.

Give intravenous digoxin if the patient is in AF. Consider: dopamine as a vasodilator, adrenalin as an inotrope, and nitrates which alter preload and afterload by vasodilation.

Consider replacement of the infected valve before irreversible heart damage occurs.


  1. Drugs and Therapeutics Bulletin (2002), 40 (4), 26-30.

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