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.