a 34 years old man with a history of a bicuspid AV is diagnosed with endocarditis. despite 2 weeks of appropriate antibiotic thrapy, he has persistent fevers and bacteremia. a diagnostic study is performed and a paravalvular abscess discovered. what's the next step in this patient's managment?

1- continue current antibiotic therapy.
2- change nafcillin to vancomycin.
3- change nafcillin to ceftriaxone.
4- add gentamycin
5- refer to surgery.

enjoy...

4- add Gentamycin to cover a boarder spectrum of the m.o. that causing the abscess...
BUT I AM NOT SURE

surgery ra2sen

ali

I concur with Ali,
Surgery is manditary...

I think it's

5-refer to surgery

that's right dear all, persistent fevers and bactermia despite 2 weeks on antibiotic therapy are indications for valve replacement surgery. other indications include progressive valvular dysfunction, developement of paravalvular abscess, and recurrnt embolic events. antibiotics alone are inadequate to treat these complications....