Despite the availability of numerous
beta-lactam antibiotics,
benzylpenicillin remains the most important
beta-lactam antibiotic in the treatment of
bacterial endocarditis.
Penicillin alone and in combination with an
aminoglycoside is effective in the treatment of
endocarditis due to all streptococci, Streptococcus pneumoniae,
penicillin-susceptible Staphylococcus aureus, Haemophilus aprophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Listeria monocytogenes. Oral
phenoxymethylpenicillin in combination with
streptomycin is effective in treating
endocarditis due to viridans streptococci.
Ampicillin is effective in
endocarditis due to Haemophilus influenzae, H. parainfluenzae, H. paraphrophilus, Listeria monocytogenes and Escherichia coli. Oral
amoxicillin with
gentamicin has been used to treat enterococcal
endocarditis. The
penicillinase-resistant
penicillins are effective in treating S. aureus
endocarditis.
Carbenicillin or
ticarcillin in combination with
tobramycin or
gentamicin are used to treat
endocarditis due to Serratia marcescens and Pseudomonas aeruginosa. The use of
piperacillin in combination with
tobramycin against P. aeruginosa
endocarditis has been associated with failure and increased resistance. The
cephalosporins have been used to treat
endocarditis caused by susceptible organisms. There have been few data on the efficacy of the newer
cephalosporins in treating
endocarditis. They have been used to treat septicaemia due to susceptible organisms with good results.