Treatment of streptomycin-susceptible and streptomycin-resistant enterococcal endocarditis.
Fifty-six patients with enterococcal endocarditis received 4 weeks of antimicrobial therapy with penicillin G and streptomycin (36 patients) or, if infections were streptomycin resistant, penicillin and gentamicin (20 patients). Compared with patients who had symptoms for less than 3 months, patients with symptoms for more than 3 months had a higher relapse rate (0% versus 44%; p less than 0.001) and mortality (2.5% versus 25%; p less than 0.001). Patients with mitral valve endocarditis had a significantly higher relapse rate (25%) than patients with aortic valve infections (0%) (p less than 0.01). Gentamicin-associated nephrotoxicity was more frequent (p less than 0.001) among patients treated with greater than 3 mg/kg d of gentamicin than among those treated with 3 mg or less (100% versus 20%). Relapse and mortality rates did not differ significantly between patients treated with low-dose or high-dose gentamicin regimens. Patients who have had symptoms of enterococcal endocarditis for more than 3 months or patients with mitral valve infection should receive at least 6 weeks of antimicrobial therapy, but patients without these high-risk factors can be treated for 4 weeks.
D000328:Adult; D000368:Aged; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D013293:Enterococcus faecalis; D005260:Female; D005839:Gentamicins / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000209:etiology; D006349:Heart Valve Diseases / Q000188:drug therapy; D006801:Humans; D007759:Labyrinth Diseases / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D010400:Penicillin G / Q000009:adverse effects / Q000627:therapeutic use*; D010403:Penicillin Resistance; D011446:Prospective Studies; D012008:Recurrence; D013290:Streptococcal Infections / Q000188:drug therapy*; D013307:Streptomycin / Q000009:adverse effects / Q000627:therapeutic use*; D014722:Vestibule, Labyrinth / Q000187:drug effects
D005839:Gentamicins; D010400:Penicillin G; D013307:Streptomycin