Antibiotics in Endocarditis due to Nutritionally Deficient Streptococci-Reply

In Reply.—  Drs Stein and Libertin assert, quite accurately, that endocardial infections due to nutritionally deficient streptococci appear to be more difficult to eradicate than are those due to other viridans streptococci. For this reason, the American Heart Association ad hoc writing group recommended that such infections be treated with a combination of intravenous aqueous crystalline penicillin G plus either streptomycin or gentamicin and that the "duration of aminoglycoside therapy should be at least two weeks."Drs Stein and Libertin question these recommendations on two counts. First, they suggest that the duration of aminoglycoside therapy should be for 4 to 6 weeks. We do not believe that existing data are adequate to settle this issue. Because such infections occur relatively infrequently, there is no large series of unselected cases of endocarditis caused by nutritionally deficient streptococci. Case reports and compilations of small numbers of patients are likely to be biased