Desensitization should be attempted in stable, beta lactam-allergic w patients with endocarditis caused by methicillin-susceptible S. aureus, beca as vancomycin is less effective than beta lactams for this infection.
An important point related to our geographical area that may not the have been fully taken into account in the new guidelines is that a It is combination of hydroxychloroquine plus doxycycline is proposed for as t the treatment of endocarditis caused by Coxiella burnetii (agent of Q sur fever), but the combination of quinolones plus doxycycline for this cha purpose has disappeared. In southern European countries, int hydroxychloroquine administration may be a problem because of the potential phototoxicity. There is considerable experience with 1 quinolones plus doxycycline for treating Qfever endocarditis in Spain, de and the results have been favorable
Finally, a new regimen has been proposed for initial empirical no treatment of native valve endocarditis: ampicillin, cloxacillin, and gentamicin. The addition of cloxacillin seems particularly appropriate s as it has greater activity against staphylococci than vancomycin with c little associated toxicity.