Treatment of Streptomycin-Susceptible and Streptomycin-Resistant Enterococcal Endocarditis
- WALTER R. WILSON, M.D.;
- CONRAD J. WILKOWSKE, M.D.;
- ALAN J. WRIGHT, M.D.;
- MERLE A. SANDE, M.D.; and
- JOSEPH E. GERACI, M.D.
Abstract
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 < 0.001) and mortality (2.5% versus 25%; p < 0.001). Patients with mitral valve endocarditis had a significantly higher relapse rate (25%) than patients with aortic valve infections (0%) (p < 0.01). Gentamicin-associated nephrotoxicity was more frequent (p < 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.
Article and Author Information
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▸From the Division of Infectious Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and the San Francisco General Hospital, University of California at San Francisco, San Francisco, California.
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▸Requests for reprints should be addressed to Walter R. Wilson, M.D.; Mayo Clinic, 200 First Street, S.W.; Rochester, MN 55905.
- © 1984 American College of Physicians
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