Which type of endocarditis is treated with vancomycin alone?

Vancomycin is an essential antibiotic in the treatment of right-sided endocarditis, particularly seen in intravenous (IV) drug users. In this population, the common pathogens include Staphylococcus aureus, which can be methicillin-resistant (MRSA), hence the need for vancomycin, which is effective against such resistant organisms.

Right-sided endocarditis often involves the tricuspid valve, and the treatment focus is on eradicating the bacteria responsible for the infection, mainly targeting Staphylococcus. Single-agent therapy with vancomycin is often sufficient in these cases given the typical organism involved and the circumstances surrounding IV drug use.

In contrast, treating native valve endocarditis typically requires a more tailored approach based on the organism identified, which may necessitate combination therapy. Prosthetic valve endocarditis also often requires treatment strategies that include other antibiotics to effectively target a broader spectrum of potential pathogens, particularly if the infection occurs early after valve placement. Similarly, left-sided endocarditis with prosthetic valves presents complexities that typically require a multi-drug regimen.

Thus, the unique scenario of right-sided endocarditis in IV drug users justifies the use of vancomycin alone due to the predictable infection profile,