Treatment of streptomycin-susceptible and streptomycin-resistant enterococcal endocarditis.

Abstract

Fifty-six patients with enterococcal endocarditis received 4 weeks of antimicrobial therapy with penicillin G and streptomycin (36 patients) or, if infections were streptomycin resistant, penicillin and gentamicin (20 patients). Compared with patients who had symptoms for less than 3 months, patients with symptoms for more than 3 months had a higher relapse rate (0% versus 44%; p less than 0.001) and mortality (2.5% versus 25%; p less than 0.001). Patients with mitral valve endocarditis had a significantly higher relapse rate (25%) than patients with aortic valve infections (0%) (p less than 0.01). Gentamicin-associated nephrotoxicity was more frequent (p less than 0.001) among patients treated with greater than 3 mg/kg d of gentamicin than among those treated with 3 mg or less (100% versus 20%). Relapse and mortality rates did not differ significantly between patients treated with low-dose or high-dose gentamicin regimens. Patients who have had symptoms of enterococcal endocarditis for more than 3 months or patients with mitral valve infection should receive at least 6 weeks of antimicrobial therapy, but patients without these high-risk factors can be treated for 4 weeks.

• Authors: W R Wilson, C J Wilkowske, A J Wright, M A Sande, J E Geraci
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 100 Issue 6 Pg. 816-23 (Jun 1984) ISSN: 0003-4819 [Print] United States
• PMID: 6426359 (Publication Type: Journal Article)

Chemical References

• Gentamicins
• Penicillin G
• Streptomycin

Topics

• Adult
• Aged
• Drug Therapy, Combination
• Endocarditis, Bacterial (complications, drug therapy, mortality)
• Enterococcus faecalis
• Female
• Gentamicins (adverse effects, therapeutic use)
• Heart Failure (etiology)
• Heart Valve Diseases (drug therapy)
• Humans
• Labyrinth Diseases (chemically induced)
• Male
• Middle Aged
• Mitral Valve
• Penicillin G (adverse effects, therapeutic use)
• Penicillin Resistance
• Prospective Studies
• Recurrence
• Streptococcal Infections (drug therapy)
• Streptomycin (adverse effects, therapeutic use)
• Vestibule, Labyrinth (drug effects)