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January 23, 1981, Vol 245, No. 4 >
ARTICLE | January 23, 1981

Short-term Therapy for Streptococcal Infective Endocarditis: Title and subTitle BreakCombined Intramuscular Administration of Penicillin and Streptomycin FREE

Walter R. Wilson, MD; Rodney L. Thompson, MD; Conrad J. Wilkowske, MD; John A. Washington, II, MD; Emilio R. Giuliani, MD; Joseph E. Geraci, MD
[+] Author Affiliations

Presented in part at the Meeting of the American Heart Association, Scientific Sessions, Anaheim, Calif, Nov 12, 1979.

Reprint requests to Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55901 (Dr Wilson).


JAMA. 1981;245(4):360-363. doi:10.1001/jama.1981.03310290028017
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References

In a prospective study, 91 patients with penicillin-sensitive infective endocarditis (IE) were treated for two weeks with intramuscular (IM) penicillin G procaine, 1.2 million units every six hours, plus streptomycin sulfate, 500 mg IM every 12 hours. Viridans streptococci were isolated from 70 patients (77%); 21 patients (23%) had Streptococcus bovis infections. Eighteen patients (20%) had had symptoms of IE for three months or longer. Follow-up ranged from two months to 6.6 years. There were no relapses; mild vestibular toxic reactions occurred in two patients (2%). Two patients (2%) died—one of sudden-onset severe heart failure and one of cardiac arrest after aortic valve replacement. Twenty-six patients (19%) required cardiac valve replacement after completion of antimicrobial therapy. This therapy seems as efficacious as four weeks of parenteral antimicrobial therapy and is more cost-effective.

(JAMA 1981;245:360-363)

REFERENCES

1 +
Geraci JE, Martin WJ:  Antibiotic therapy of bacterial endocarditis: IV. Successful short-term (two weeks) combined penicillin-dihydrostreptomycin therapy in subacute bacterial endocarditis caused by penicillin-sensitive streptococci . Circulation 1953;;8:494-509.
2 +
Geraci JE:  Further experiences with short-term (two weeks) combined penicillin-streptomycin therapy for bacterial endocarditis caused by penicillin-sensitive streptococci . Proc Staff Meet Mayo Clin 1955;;30:192-200.
3 +
Geraci JE:  The antibiotic therapy of bacterial endocarditis: Therapeutic data on 172 patients seen from 1951 through 1957; additional observations on short-term therapy (two weeks) for penicillin-sensitive streptococcal endocarditis . Med Clin North Am , (July) 1958;, pp 1101-1140.
4 +
Hunter TH:  The treatment of some bacterial infections of the heart and pericardium . Bull NY Acad Med 1952;;28:213-228.
5 +
Wilson WR, Geraci JE, Wilkowske CJ, et al:  Short-term intramuscular therapy with procaine penicillin plus streptomycin for infective endocarditis due to viridans streptococci . Circulation 1978;;57:1158-1161.
6 +
Friedberg CK: Diseases of the Heart , ed 3. Philadelphia, WB Saunders Co, 1966;, vol 1, p 242.
7 +
Karchmer AW, Moellering RC Jr, Maki DG, et al:  Single-antibiotic therapy for streptococcal endocarditis . JAMA 1979;;241:1801-1806.
8 +
Hoppes WL:  Treatment of bacterial endocarditis caused by penicillin-sensitive streptococci . Arch Intern Med 1977;;137:1122-1123.
9 +
Malacoff RF, Frank E, Andriole VT:  Streptococcal endocarditis (nonenterococcal, nongroup A): Single vs combination therapy . JAMA 1979;;241:1807-1810.
10 +
Wolfe JC, Johnson WD Jr:  Penicillinsensitive streptococcal endocarditis: In-vitro and clinical observations on penicillin-streptomycin therapy . Ann Intern Med 1974;;81:178-181.
11 +
Durack DT, Petersdorf RG:  Chemotherapy of experimental streptococcal endocarditis: I. Comparison of commonly recommended prophylactic regimens . J Clin Invest 1973;;52:592-598.
12 +
Tompsett R, Hurst ML:  Bacterial endocarditis: Selected aspects of treatment . Trans Am Clin Climatol Assoc 1971;;83:95-101.
13 +
Phair JP, Tan JS:  Therapy of Streptococcus viridans endocarditis , in Kaplan EL, Taranta AV (eds): Infective Endocarditis . Dallas, American Heart Association, 1977;, pp 55-57.
14 +
Hunter TH, Paterson PY:  Bacterial endocarditis . DM , (November) 1956;, pp 1-48.
15 +
Tompsett R, Robbins WC, Berntsen C Jr:  Short-term penicillin and dihydrostreptomycin therapy of streptococcal endocarditis: Results of the treatment of 35 patients . Am J Med 1958;; 24:57-67.
16 +
Tan JS, Terhune CA Jr, Kaplan S, et al:  Successful two-week treatment schedule for penicillin-susceptible Streptococcus viridans endocarditis . Lancet 1971;;2:1340-1343.
17 +
Hook EW, Guerrant RL:  Therapy of infective endocarditis , in Kaye D (ed): Infective Endocarditis . Baltimore, University Park Press, 1976;, pp 169, 172, 173.
18 +
Kaye D, McCormack RC, Hook EW: Bacterial endocarditis: The changing pattern since the introduction of penicillin therapy. Antimicrob Agents Chemother 1961-1962, pp 37-46.
19 +
 Health care institutions , in Schechter DS: American Hospital Association Guide to the Health Care Field . Chicago, American Hospital Association, 1978;, pp A7-A15.

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1 +
Geraci JE, Martin WJ:  Antibiotic therapy of bacterial endocarditis: IV. Successful short-term (two weeks) combined penicillin-dihydrostreptomycin therapy in subacute bacterial endocarditis caused by penicillin-sensitive streptococci . Circulation 1953;;8:494-509.
2 +
Geraci JE:  Further experiences with short-term (two weeks) combined penicillin-streptomycin therapy for bacterial endocarditis caused by penicillin-sensitive streptococci . Proc Staff Meet Mayo Clin 1955;;30:192-200.
3 +
Geraci JE:  The antibiotic therapy of bacterial endocarditis: Therapeutic data on 172 patients seen from 1951 through 1957; additional observations on short-term therapy (two weeks) for penicillin-sensitive streptococcal endocarditis . Med Clin North Am , (July) 1958;, pp 1101-1140.
4 +
Hunter TH:  The treatment of some bacterial infections of the heart and pericardium . Bull NY Acad Med 1952;;28:213-228.
5 +
Wilson WR, Geraci JE, Wilkowske CJ, et al:  Short-term intramuscular therapy with procaine penicillin plus streptomycin for infective endocarditis due to viridans streptococci . Circulation 1978;;57:1158-1161.
6 +
Friedberg CK: Diseases of the Heart , ed 3. Philadelphia, WB Saunders Co, 1966;, vol 1, p 242.
7 +
Karchmer AW, Moellering RC Jr, Maki DG, et al:  Single-antibiotic therapy for streptococcal endocarditis . JAMA 1979;;241:1801-1806.
8 +
Hoppes WL:  Treatment of bacterial endocarditis caused by penicillin-sensitive streptococci . Arch Intern Med 1977;;137:1122-1123.
9 +
Malacoff RF, Frank E, Andriole VT:  Streptococcal endocarditis (nonenterococcal, nongroup A): Single vs combination therapy . JAMA 1979;;241:1807-1810.
10 +
Wolfe JC, Johnson WD Jr:  Penicillinsensitive streptococcal endocarditis: In-vitro and clinical observations on penicillin-streptomycin therapy . Ann Intern Med 1974;;81:178-181.
11 +
Durack DT, Petersdorf RG:  Chemotherapy of experimental streptococcal endocarditis: I. Comparison of commonly recommended prophylactic regimens . J Clin Invest 1973;;52:592-598.
12 +
Tompsett R, Hurst ML:  Bacterial endocarditis: Selected aspects of treatment . Trans Am Clin Climatol Assoc 1971;;83:95-101.
13 +
Phair JP, Tan JS:  Therapy of Streptococcus viridans endocarditis , in Kaplan EL, Taranta AV (eds): Infective Endocarditis . Dallas, American Heart Association, 1977;, pp 55-57.
14 +
Hunter TH, Paterson PY:  Bacterial endocarditis . DM , (November) 1956;, pp 1-48.
15 +
Tompsett R, Robbins WC, Berntsen C Jr:  Short-term penicillin and dihydrostreptomycin therapy of streptococcal endocarditis: Results of the treatment of 35 patients . Am J Med 1958;; 24:57-67.
16 +
Tan JS, Terhune CA Jr, Kaplan S, et al:  Successful two-week treatment schedule for penicillin-susceptible Streptococcus viridans endocarditis . Lancet 1971;;2:1340-1343.
17 +
Hook EW, Guerrant RL:  Therapy of infective endocarditis , in Kaye D (ed): Infective Endocarditis . Baltimore, University Park Press, 1976;, pp 169, 172, 173.
18 +
Kaye D, McCormack RC, Hook EW: Bacterial endocarditis: The changing pattern since the introduction of penicillin therapy. Antimicrob Agents Chemother 1961-1962, pp 37-46.
19 +
 Health care institutions , in Schechter DS: American Hospital Association Guide to the Health Care Field . Chicago, American Hospital Association, 1978;, pp A7-A15.

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