Streptococcal infections endocarditis

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 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. 

Patients with rheumatic fever have heart-reactive antibodies in their sera. In addition, these antibodies are at higher titre than in people with streptococcal infection and no rheumatic fever. In addition, they persist for up to three years following an acute attack — the period of time at which patients are at risk of recurrence. A rise in antibodies is seen at the time of second attacks when these are associated with endocarditis. 

Apart from this modest, localized form, a generalized skin condition is observed in rare cases, as well as systemic forms with endocarditis. Differential diagnosis must be made with erysipelas, a febrile streptococcal infection with a rapid extension. The disease does not leave any immunity and re-infection is therefore possible. The bacteria responsible can be cultured from bioptic cells obtained from the margins of the lesion or from the blood in systemic forms. The disease can be treated with penicillin or tetracycline for 1 week. 

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. 

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. 

Penicillin, a naturally occurring antibiotic, is indicated in the treatment of group A streptococcal upper respiratory infections, prophylaxis of poststreptococcal rheumatic fever, syphihs of less than one year s duration, moderate to severe systemic infections, uncomphcated gonorrhea, pneumococcal pneumonia, and endocarditis prophylaxis for dental surgery (see Table 23). 

Natural penicillin Infections like streptococcal pneumonia, enterococcal and nonenterococcal group D endocarditis, diphtheria, anthrax, meningitis, tetanus, botulism, actinomycosis, syphilis, and relapsing fever, Lyme disease prophylaxis against pneumococcal infections, rheumatic fever, bacterial endocarditis... 

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