Biomaterial Database

Treatment of endocarditis caused by relatively resistant nonenterococcal streptococci: is penicillin enough? 1990

M J DiNubile

University of Medicine and Dentistry/Robert Wood Johnson Medical School, Camden, New Jersey.

Most cases of endocarditis are caused by nonenterococcal streptococci. Some of these organisms are classified as relatively resistant to penicillin on the basis of minimum inhibitory concentrations (MICs) greater than 0.1-0.2 microgram/mL. Almost all authorities recommend that endocarditis caused by relatively resistant streptococci be treated with high doses of penicillin combined with 2-6 weeks of an aminoglycoside rather than the potentially shorter, less toxic, and more flexible regimens used for exquisitely sensitive streptococci (MIC, less than 0.1-0.2 microgram of penicillin/mL). The data to support this recommendation are limited and inconclusive. We review the relevant clinical experience, experimental models, and theoretical considerations. Penicillin alone is probably adequate therapy for most cases of native valve endocarditis caused by relatively resistant streptococci; in certain patients, it may be the preferred treatment.

UI	MeSH Term	Description	Entries
D010403	Penicillin Resistance	Nonsusceptibility of an organism to the action of penicillins.	Penicillin Resistances,Resistance, Penicillin,Resistances, Penicillin
D010406	Penicillins	A group of antibiotics that contain 6-aminopenicillanic acid with a side chain attached to the 6-amino group. The penicillin nucleus is the chief structural requirement for biological activity. The side-chain structure determines many of the antibacterial and pharmacological characteristics. (Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed, p1065)	Antibiotics, Penicillin,Penicillin,Penicillin Antibiotics
D004359	Drug Therapy, Combination	Therapy with two or more separate preparations given for a combined effect.	Combination Chemotherapy,Polychemotherapy,Chemotherapy, Combination,Combination Drug Therapy,Drug Polytherapy,Therapy, Combination Drug,Chemotherapies, Combination,Combination Chemotherapies,Combination Drug Therapies,Drug Polytherapies,Drug Therapies, Combination,Polychemotherapies,Polytherapies, Drug,Polytherapy, Drug,Therapies, Combination Drug
D004697	Endocarditis, Bacterial	Inflammation of the ENDOCARDIUM caused by BACTERIA that entered the bloodstream. The strains of bacteria vary with predisposing factors, such as CONGENITAL HEART DEFECTS; HEART VALVE DISEASES; HEART VALVE PROSTHESIS IMPLANTATION; or intravenous drug use.	Bacterial Endocarditides,Bacterial Endocarditis,Endocarditides, Bacterial
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000617	Aminoglycosides	Glycosylated compounds in which there is an amino substituent on the glycoside. Some of them are clinically important ANTIBIOTICS.	Aminoglycoside
D000900	Anti-Bacterial Agents	Substances that inhibit the growth or reproduction of BACTERIA.	Anti-Bacterial Agent,Anti-Bacterial Compound,Anti-Mycobacterial Agent,Antibacterial Agent,Antibiotics,Antimycobacterial Agent,Bacteriocidal Agent,Bacteriocide,Anti-Bacterial Compounds,Anti-Mycobacterial Agents,Antibacterial Agents,Antibiotic,Antimycobacterial Agents,Bacteriocidal Agents,Bacteriocides,Agent, Anti-Bacterial,Agent, Anti-Mycobacterial,Agent, Antibacterial,Agent, Antimycobacterial,Agent, Bacteriocidal,Agents, Anti-Bacterial,Agents, Anti-Mycobacterial,Agents, Antibacterial,Agents, Antimycobacterial,Agents, Bacteriocidal,Anti Bacterial Agent,Anti Bacterial Agents,Anti Bacterial Compound,Anti Bacterial Compounds,Anti Mycobacterial Agent,Anti Mycobacterial Agents,Compound, Anti-Bacterial,Compounds, Anti-Bacterial
D013290	Streptococcal Infections	Infections with bacteria of the genus STREPTOCOCCUS.	Group A Strep Infection,Group A Streptococcal Infection,Group A Streptococcal Infections,Group B Strep Infection,Group B Streptococcal Infection,Group B Streptococcal Infections,Infections, Streptococcal,Infection, Streptococcal,Streptococcal Infection
D013291	Streptococcus	A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment.