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Treatment of Streptomycin-Susceptible and Streptomycin-Resistant Enterococcal Endocarditis

WALTER R. WILSON, M.D.; CONRAD J. WILKOWSKE, M.D.; ALAN J. WRIGHT, M.D.; MERLE A. SANDE, M.D.; and JOSEPH E. GERACI, M.D.
[+] Article and Author Information

▸Requests for reprints should be addressed to Walter R. Wilson, M.D.; Mayo Clinic, 200 First Street, S.W.; Rochester, MN 55905.


Rochester, Minnesota; and San Francisco, California


© 1984 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1984;100(6):816-823. doi:10.7326/0003-4819-100-6-816
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Fifty-six patients with enterococcal endocarditis received 4 weeks of antimicrobial therapy with penicillin G and streptomycin (36 patients) or, if infections were streptomycin resistant, penicillin and gentamicin (20 patients). Compared with patients who had symptoms for less than 3 months, patients with symptoms for more than 3 months had a higher relapse rate (0% versus 44%; p < 0.001) and mortality (2.5% versus 25%; p < 0.001). Patients with mitral valve endocarditis had a significantly higher relapse rate (25%) than patients with aortic valve infections (0%) (p < 0.01). Gentamicin-associated nephrotoxicity was more frequent (p < 0.001) among patients treated with greater than 3 mg/kg d of gentamicin than among those treated with 3 mg or less (100% versus 20%). Relapse and mortality rates did not differ significantly between patients treated with low-dose or high-dose gentamicin regimens. Patients who have had symptoms of enterococcal endocarditis for more than 3 months or patients with mitral valve infection should receive at least 6 weeks of antimicrobial therapy, but patients without these high-risk factors can be treated for 4 weeks.

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