Conclusion and results
Based on the clinical history, examination, laboratory and
echocardiography, provisional diagnosis of Right sided IE following
Septic Abortion was made. Right sided IE was made following modified
Duke’s criteria (16). The patient was initiated on
piperacillin-tazobactam (4.5 g IV QID) for the treatment of suspected
bacterial infection, particularly due to the presence of
methicillin-resistant Staphylococcus aureus (MRSA) in blood cultures.
Vancomycin (1 g IV BD) was added to target MRSA, which is resistant to
many other antibiotics. Gentamicin (80 mg IV BD) was prescribed as an
additional broad-spectrum antibiotic to cover Gram-negative organisms,
especially in the context of sepsis and possible systemic infections.
Pantoprazole (40 mg PO OD) was given to prevent stress-related gastric
acid secretion and reduce the risk of gastrointestinal bleeding,
commonly associated with prolonged illness and antibiotic use.
Paracetamol (1 g IV QID) was used for symptomatic management of fever.
Multivitamins (1 capsule PO OD) were prescribed to address any potential
nutritional deficiencies during illness. Probiotic (15 mL PO TDS) was
included to maintain gut flora balance, particularly to counteract the
disruption caused by broad-spectrum antibiotics. Lactulose (½ tablet PO
OD) was prescribed to manage constipation, which can be a side effect of
opioid analgesics or immobility in hospitalized patients. Four units of
packed red blood cells (PRBC) were transfused, improving her hemoglobin
level to 9.6 g/dL. Due to the patient’s family request, she was referred
to a higher center for further management.