Penicillin sensitive nutritionally variant streptococcal endocarditis: relapse after penicillin therapy.

Abstract

Studies to date have indicated that nutritionally-variant streptococci (NVS) causing bacterial endocarditis are frequently inhibited but not killed by low concentrations of penicillin. We report a patient with endocarditis due to a NVS strain which was killed in vitro by penicillin at a concentration of 0.09 microgram/ml. Despite therapy with intravenous penicillin for four weeks, the infection relapsed and was then cured by combined penicillin-gentamicin in therapy. In vitro studies demonstrated a synergistic effect of these two antibiotics. This experience suggests that combination therapy with penicillin and an aminoglycoside may be required for cure of all cases of nutritionally-variant streptococcal endocarditis regardless of in vitro susceptibility to penicillin.

• Authors: J F Levine, B A Hanna, A A Pollock, M S Simberkoff, J J Rahal Jr
• Journal: The American journal of the medical sciences (Am J Med Sci) 1983 Jul-Aug Vol. 286 Issue 1 Pg. 31-6 ISSN: 0002-9629 [Print] United States
• PMID: 6553451 (Publication Type: Case Reports, Journal Article)

Chemical References

• Gentamicins
• Penicillins

Topics

• Aged
• Drug Synergism
• Endocarditis, Bacterial (drug therapy)
• Gentamicins (pharmacology, therapeutic use)
• Humans
• Male
• Microbial Sensitivity Tests
• Penicillin Resistance
• Penicillins (pharmacology, therapeutic use)
• Recurrence
• Streptococcal Infections (drug therapy)
• Streptococcus (drug effects)