Endocarditis streptococcal

Serious streptococcal infections, such 150,000 units/kg/day divided in as pneumonia and endocarditis (S. equal doses every 4 to 6 h pneumoniae) and meningococcus... 

Streptococcal Infections Therapy must be sufficient to eliminate the organism (minimum, 10 days) otherwise, sequelae (eg, endocarditis, rheumatic fever) may occur. 

Streptococcal Vancomycin is effective alone or in combination with an aminoglycoside for endocarditis caused by S. virldans or S. bovis. It is only effective in combination with an aminoglycoside for endocarditis caused by enterococci (eg, S. faecal Is). 

Streptococci are generally highly sensitive to penicillin G (MIC <0.1 mg/1), albeit that some strains are more resistant (MIC O.I-I.O mg/1). Thus, streptococcal endocarditis can be treated with a... 

Streptococcal infections Pharyngitis, rheumatic fever, otitis media and even for subacute bacterial endocarditis. Staphylococcal infections Penicillinase resistant penicillin can be used. Meningococcal infections Meningitis other infections caused by meningococci. 

Penicillin plus streptomycin is effective for enterococcal endocarditis and 2-week therapy of viridans streptococcal endocarditis. Gentamicin has largely replaced streptomycin for these indications. Streptomycin remains a useful agent for treating enterococcal infections, however, because approximately 15% of enterococcal isolates that are resistant to gentamicin (and therefore to netilmicin, tobramycin, and amikacin) will be susceptible to streptomycin. 

Bacterial endocarditis. An aminoglycoside, usually gentamicin, should comprise part of the antimicrobial combination for enterococcal, streptococcal or staphylococcal infection of the heart valves, and for the therapy of clinical endocarditis which fails to yield a positive blood culture. 

Dajani A, Taubert K, Eerrieri P, et al. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever A statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association. Pediatrics 1995 96 758-764. 

S-Lactam antibiotics, such as penicillin G, nafcillin, and ampicillin, remain the drugs of choice for streptococcal, staphylococcal, and enterococcal endocarditis, respectively. 

The BSAC guidelines suggest that all the following conditions be present to consider a 2-week treatment regimen for penicillin-sensitive streptococcal endocarditis ... 

Shorter-course antimicrobial regimens are advocated when possible. For instance, in exquisitely sensitive streptococcal endocarditis (MICs <0.1 mcg/mL), a 2-week regimen of high-dose parenteral penicillin G in combination with an aminoglycoside is as effective as 4 weeks of penicillin alone. Uncomplicated right-sided MSSA endocarditis in the intravenous drug abuser also may be treated with... 

Gavalda J, Pahissa A, Almirante B, et al. Effect of gentamicin dosing interval on therapy of viridans streptococcal experimental endocarditis with gentamicin plus penicillin. Antimicrob Agents Chemother 1995 39 2098-2103. 

FrancioU P, Ruch W, Stamboulian D, et al. Treatment of streptococcal endocarditis with a single daily dose of ceftriaxone and netilmicin for 14 days A prospective multicenter study. Clin Infect Dis 1995 21 1406-1410. 

Sexton DJ, Tenenbaum Ml, Wilson WR, et al. Ceftriaxone once daily for 4 weeks compared to ceftriaxone plus gentamicin once daily for 2 weeks for treatment of penicillin-susceptible streptococcal endocarditis. Clin Infect Dis 1998 27 1470-1474. 

---