Short-term therapy for streptococcal infective endocarditis. Combined intramuscular administration of penicillin and streptomycin

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Abstract
In a prospective study, 91 patients with penicillin-sensitive infective endocarditis (IE) were treated for 2 wk with i.m. penicillin G procaine, 1.2 million units every 6 h, plus streptomycin sulfate, 500 mg i.m. every 12 h. Viridans streptococci were isolated from 70 patients (77%); 21 patients (23%) had Streptococcus bovis infections. Eighteen patients (20%) had had symptoms of IE for 3 mo. or longer. Follow-up ranged from 2 mo. to 6.6 yr. There were no relapses; mild vestibular toxic reactions occurred in 2 patients (2%). Two patients (2%) died, one of sudden-onset severe heart failure and one of cardiac arrest after aortic valve replacement. Twenty-six patients (19%) required cardiac valve replacement after completion of antimicrobial therapy. This therapy seems as efficacious as 4 wk of parenteral antimicrobial therapy and is more cost-effective.