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Antibiotics in Endocarditis due to Nutritionally Deficient Streptococci FREE

Daniel S. Stein, MD; Claudia R. Libertin, MD
JAMA. 1989;262(5):618-618. doi:10.1001/jama.1989.03430050028020
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To the Editor.—  Recently, the American Heart Association's Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease1 gave their recommendations for the treatment of streptococcal endocarditis, including that caused by nutritionally deficient variants. We feel their recommendation of 4 weeks of intravenous penicillin with at least 2 weeks of an aminoglycoside for treatment of endocarditis caused by nutritionally deficient variants deserves comment.Previous studies2-4 have demonstrated the isolation of penicillin-resistant strains5 and that minimal inhibitory concentrations to penicillin of 0.12 μg/mL or greater occur in up to one third of the strains tested. In clinical use, the therapy of penicillin and an aminoglycoside for nutritionally deficient streptococcal endocarditis has resulted in persistently positive blood cultures or positivevalue culture in 38% of the cases reviewed,5 as compared with the 25% failure rate noted in enterococcal endocarditis.1 Mortality in patients with nutritionally deficient streptococcal endocarditis who received penicillin

REFERENCES

Bisno AL, Dismukes WE, Durack DT, et al.  Antimicrobial treatment of infective endocarditis due to viridans streptococci, enterococci, and staphylococci . JAMA. 1989;; 261:1471-1477.
Cooksey RC, Swenson JM.  In vitro antimicrobial inhibition patterns of nutritionally variant streptococci . Antimicrob Agents Chemother. 1979;;16:514-518.
McCarthy LR, Bottone EJ.  Bacteremia and endocarditis caused by satelliting streptococci . Am J Clin Pathol. 1974;;61:585-591.
Roberts RB, Rrieger AG, Schiller ML, Gross RC.  Viridans streptococcal endocarditis: the role of various species, including pyridoxal-dependent streptococci . Rev Infect Dis. 1979;;1:955-965.
Stein DS, Nelson RE.  Endocarditis due to nutritionally deficient streptococci: therapeutic dilemma . Rev Infect Dis. 1987;;9:908-916.
Wilson WE, Wilkowske CJ, Wright AJ, Sande MA, Geraci JE:  Treatment of streptomycin-susceptible and streptomycin-resistant enterococcal endocarditis . Ann Intern Med. 1984;;100:816-823.
Henry MR, Wilson WE, Roberts RB, Acar JF, Geraci JE.  Antimicrobial therapy of experimental endocarditis caused by nutrionally variant viridans group streptococci . Antimicrob Agents Chemother. 1986;;30:465-467.
Stein DS, Libertin CR.  Time kill curve analysis of vancomycin and rifampin alone and in combination against nine strains of nutritionally deficient streptococci . Diagn Microbiol Infect Dis. 1988;;10:139-144.
Stein DS, Libertin CR.  Time-kill curve analysis of antimicrobial therapy: penicillin (PCM) + gentamicin (GM); vancomycin (V) + rifampin (RIF) in nutritionally deficient streptococci . In: Abstracts of the 88th annual meeting of the American Society for Microbiology; May 8-13, 1988; Miami Beach, Fla . Abstract A87.

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Bisno AL, Dismukes WE, Durack DT, et al.  Antimicrobial treatment of infective endocarditis due to viridans streptococci, enterococci, and staphylococci . JAMA. 1989;; 261:1471-1477.
Cooksey RC, Swenson JM.  In vitro antimicrobial inhibition patterns of nutritionally variant streptococci . Antimicrob Agents Chemother. 1979;;16:514-518.
McCarthy LR, Bottone EJ.  Bacteremia and endocarditis caused by satelliting streptococci . Am J Clin Pathol. 1974;;61:585-591.
Roberts RB, Rrieger AG, Schiller ML, Gross RC.  Viridans streptococcal endocarditis: the role of various species, including pyridoxal-dependent streptococci . Rev Infect Dis. 1979;;1:955-965.
Stein DS, Nelson RE.  Endocarditis due to nutritionally deficient streptococci: therapeutic dilemma . Rev Infect Dis. 1987;;9:908-916.
Wilson WE, Wilkowske CJ, Wright AJ, Sande MA, Geraci JE:  Treatment of streptomycin-susceptible and streptomycin-resistant enterococcal endocarditis . Ann Intern Med. 1984;;100:816-823.
Henry MR, Wilson WE, Roberts RB, Acar JF, Geraci JE.  Antimicrobial therapy of experimental endocarditis caused by nutrionally variant viridans group streptococci . Antimicrob Agents Chemother. 1986;;30:465-467.
Stein DS, Libertin CR.  Time kill curve analysis of vancomycin and rifampin alone and in combination against nine strains of nutritionally deficient streptococci . Diagn Microbiol Infect Dis. 1988;;10:139-144.
Stein DS, Libertin CR.  Time-kill curve analysis of antimicrobial therapy: penicillin (PCM) + gentamicin (GM); vancomycin (V) + rifampin (RIF) in nutritionally deficient streptococci . In: Abstracts of the 88th annual meeting of the American Society for Microbiology; May 8-13, 1988; Miami Beach, Fla . Abstract A87.
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