Intravenous Followed by Oral Antimicrobial Therapy for Staphylococcal Endocarditis

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Abstract
Cases (35) of staphylococcal endocarditis in 33 patients were treated with i.v. followed by oral antimicrobial therapy. All patients had 3 or more blood cultures positive for Staphylococcus aureus and all had cardiac murmurs characteristic of valvular insufficiency. The mean total duration of antimicrobial therapy was 42.4 d [days], consisting of a mean of 16.4 d of i.v. therapy followed by a mean of 26 d of oral therapy. I.v. antimicrobial therapy included sodium nafcillin (32 cases; mean dose 9.2 g daily) and clindamycin (3 cases). Oral therapy included dicloxacillin or oxacillin (30 cases; mean dose 4.5 g daily), clindamycin (4 cases) and potassium penicillin V (1 case). Serum bactericidal titers using the blood culture isolates showed similar activity with i.v. and oral drugs. All patients treated with this sequential i.v. and oral regimen were cured. A regimen of initial i.v. followed by oral antimicrobial therapy, monitored with serum antibacterial activity studies, is a safe, effective, well-tolerated and economical treatment for staphylococcal endocarditis.

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