Pseudomonas Endocarditis-Reply

We appreciate the comments of Drs Reyes and Lerner based on their considerable experience with Pseudomonas endocarditis in heroin addicts. It was not the purpose of our article to suggest that patients whose temperatures defervesce rapidly without therapy never have Pseudomonas endocarditis. Indeed, we specifically stated that such a clinical course "does not imply that treatment with appropriate antibiotics should be withheld from addicts with fever, pleuritic chest pain, and heart murmurs, since it is impossible to predict which drug abusers will follow this more benign course." We go on to state that in such patients, the clinical condition should be reevaluated, and the plan of therapy should be reconsidered, particularly when defervescence occurs within 24 hours of the initiation of antibiotic therapy. It may be possible to treat such patients with an abbreviated antibiotic course rather than the full six-week course recommended by Drs Reyes and Lerner.