Treatment of Bacterial Endocarditis in Patients with Penicillin Hypersensitivity

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Abstract
A series of 400 cases of bacterial endocarditis was reviewed. Seventy-one (18%) gave a history of penicillin allergy. Fifty-six of these required penicillin therapy and 22 (39%) had an allergic reaction. In contrast, only 6% of those with no history of penicillin allergy had a reaction to penicillin therapy. There were no deaths from allergic reactions, and penicillin therapy was completed, with the aid of antihistamine and corticosteroid therapy, in all but 8 of the 40 patients who had an allergic reaction. An adequately bactericidal regimen of nonpenicillin antibiotics should be used if possible in any patient with bacterial endocarditis and a history of penicillin allergy, especially if the skin reaction to penicillin is positive. However, some patients with bacterial endocarditis and a history of penicillin allergy will still require penicillin therapy for survival. These should be given the drug cautiously and in full knowledge of the risk involved.