Single-antibiotic therapy for streptococcal endocarditis

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Abstract
Ninety-nine patients treated with penicillin G potassium, cephalothin sodium or vancomycin hydrochloride were studied to evaluate single-drug therapy for nonenterococcal streptococcal endocarditis. Eighty-six patients survived; of these, 66 received penicillin alone. The maximum serum bactericidal titer obtained at the expected nadir of serum antibiotic concentration was 1:8 or greater in 70 (95%) of the 74 patients studied. No relapse occurred among the 66 patients treated with penicillin. Only 1 patient experienced a relapse that occurred following therapy with suboptimal doses of vancomycin. Distinct 2nd episodes of endocarditis occurred in 5 patients. While 13 patients died, none died of intractable infection. The treatment of endocarditis due to penicillin-susceptible streptococci with high-dose parenteral penicillin or a bactericidal penicillin substitute for 4 wk or longer results in bacteriologic cure rates comparable with those achieved with combined penicillin-streptomycin regimens.