Abstract
This is in response to comments by Dr Ashok on our recently published article in Quarterly Journal of Medicine: An International Journal of Medicine.1 We agree that the choice of empirical antibiotics is Vancomycin plus Gentamycin, and our patient received the same in the later course of the stay in hospital. Valve surgery was considered in our patient and could not be done because of his rapid deterioration and short duration of hospitalization. Valve repair is indicated mainly for mitral and tricuspid valves. Standard indications of valve surgery include large mobile vegetations (>10 mm), heart failure or persistence of sepsis despite adequate antibiotic coverage for 5–7 days.2 Emergency indications (within 48 h) for surgery are severe regurgitation, outflow obstruction, refractory acute pulmonary oedema, cardiogenic shock or very large mobile vegetations (>15–20 mm).3 Conflict of interest: None declared.
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