Antibiotic Therapy for MRSA-Associated Endocarditis: New Recommendations

In my “What’s Wrong With This Picture?” case of a patient with community-acquired native valve infective endocarditis (CONSULTANT,  August 2005, page 1016), I described recommended treatments for native valve endocarditis caused by methicillin-sensitive Staphylococcus aureus and methicillin-resistant S aureus (MRSA).

Jonathan Blum, MD, PhD, recently brought to my attention that the new guidelines1  recommend a different regimen for patients with native valve endocarditis caused by MRSA. According to these guidelines, vancomycin can initially be given alone, at 12-hour intervals. However, if bacteremia persists beyond 1 week, a second agent (either rifampin or gentamicin) can be added.2

 I am grateful to Dr Blum for alerting me to this change in the guidelines.

— Navin M. Amin, MD
Chairman of Family Medicine and Pediatrics 
Kern Medical Center
Bakersfield, Calif
Professor of Family Medicine
University of California at Irvine
Associate Professor of Medicine
University of California at Los Angeles
Associate Professor of Family Medicine
Stanford University School of Medicine
Stanford, Calif


1. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis—diagnosis, antimicrobial therapy and management of complications. Circulation. 2005;111: e394-e433.

2. Levine DB, Fromm BS, Reddy BR. Slow response to vancomycin or vancomycin plus rifampin in methicillin-resistant Staphylococcus aureus endocarditis. Ann Intern Med. 1991;115:674-680.