Treatment of penicillin-sensitive streptococcal infective endocarditis.
Patients with infective endocarditis caused by penicillin-sensitive streptococci (minimal inhibitory concentration less than or equal to 0.1 microgram/ml of penicillin) may be treated successfully with one of the following three regimens: (1) aqueous penicillin G administered intravenously for 4 weeks, (2) aqueous penicillin G administered intravenously for 4 weeks in combination with streptomycin for the first 2 weeks of therapy, or (3) parenterally administered penicillin plus streptomycin for 2 weeks. No substantial difference in the relapse rate exists among the three regimens, and a cure rate of at least 98% may be anticipated with each of the three forms of therapy. The major advantage of the 2-week regimen is that it is more cost-effective than 4 weeks of hospitalization and therapy. The major disadvantage of the 2-week regimen and the 4-week regimen that uses streptomycin is the relatively low risk of streptomycin-associated vestibular toxicity. Patients unable to tolerate penicillin may be treated with vancomycin or a cephalosporin administered parenterally for 4 weeks.
D000328:Adult; D000368:Aged; D002511:Cephalosporins / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000008:administration & dosage*; D010402:Penicillin G Procaine / Q000008:administration & dosage*; D013290:Streptococcal Infections / Q000188:drug therapy*; D013307:Streptomycin / Q000008:administration & dosage*; D014640:Vancomycin / Q000008:administration & dosage
D002511:Cephalosporins; D010402:Penicillin G Procaine; D014640:Vancomycin; D010400:Penicillin G; D013307:Streptomycin