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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aminoglycoside antibiotics are reviewed with regard to mechanism of action, bacterial resistance, antimicrobial spectrum, combinations with other agents, pharmacology, dosages in patients with normal and impaired renal function, adverse reactions, therapeutic use, prophylatic use and selection. Streptomycin is suggested in the therapy of tuberculosis, brucellosis, tularemia and yersinia infections; several of these require the coadministration of another agent. The choice between streptomycin and gentamicin for combination therapy of enterococcal endocarditis may be simplified by knowledge of the prevalence of high-level streptomycin-resistant strains in the hospital or by use of an in vitro screening test. Neomycin is the agent used orally in the treatment of hepatic encephalopathy. Paromomycin is indicated only for the treatment of amebic infections. The major difference among gentamicin, tobramycin and amikacin lies in the low but increasing prevalence of gram-negative bacilli which are resistant to gentamicin and tobramycin and susceptible to amikacin. In those institutions in which gentamicin-resistant strains are of concern, amikacin is the aminoglycoside of choice in high-risk patients until the infecting bacterium has been determined.
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PMID:Drug therapy reviews: Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics--part 4: aminoglycosides. 40 90

Brucella endocarditis is a rare, but often fatal, complication of brucellosis. A 32 year old man acquired brucellosis while on a visit to his former home in Greece and presented six months later with malaise, fever and aortic regurgitation. Blood cultures grew Brucella melitensis biotype 1. Combined chemotherapy with streptomycin, tetracycline and rifampin sterilized his blood; however, his aortic valve was replaced owing to recurrent emboli and cardiac failure. Over the next 18 months the patient's antibody titer to Brucella fell and his blood reamined sterile. Cure was achieved by resection of the infected aortic valve and 10 weeks of bactericidal therapy for B. melitensis.
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PMID:Successful treatment of Brucella melitensis end-carditis. 64 54

A brief account of the aims sought by multiple antibiotic management is followed by an assessment of the antagonism and synergism displayed by associations of two bactericidal antibiotics, two bacteriostatic antibiotics, and one bactericidal and one bacteriostatic antibiotic. Instances of synergism between bactericides (particularly penicillins and aminosides) are mentioned. Stress is laid on recent studies on the mechanism of action of antibacterial drugs showing unmistakeable synergism between trimethoprim and sulphamethoxazol and between chloramphenicol and tetracycline. The antagonism between bactericides and bacteriostatics noted by Jawetz et Al. has not been confirmed clinically in a number of reported series. The main indications for combined antiobiotic therapy are reviewed: endocarditis, purulent meningitis, staphylococcia, brucellosis, salmonellosis, shigellosis, other Gram-negative infections and fever in the course of blood diseases. References is made to personal experience in the management of 35 cases of bacterial endocarditis, 15 cases of purulent meningitis and various forms of serious Gram-negative infection. Leaving aside exceptional cases, the clinical effects of antibiotic associations are uncertain and influenced by too many variables. The technique is still of importance, however, despite the introduction of many new antibiotics. It must not be thought of as a handy method for indiscriminate use, however; its indications (which are summarised) are quite clear.
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PMID:[Further aspects of combination antibiotic therapy. Critical review and personal case studies]. 116 Nov 72

The effectiveness of treatment of human brucellosis caused by Brucella melitensis with ciprofloxacin alone was investigated in a prospective nonrandomized study. Subjects with central nervous system involvement, endocarditis, or severe renal dysfunction; children under 16 years of age; and pregnant women were excluded from the study. Of 19 patients, 16 completed the study; 7 were diagnosed as having acute systemic brucellosis, and 9 had acute brucella arthritis-diskitis. A rapid response to ciprofloxacin was seen in all 16 patients, but the blood cultures of 1 patient remained positive and the treatment was changed. During a 104-week follow-up period, 4 of the 15 responding patients relapsed or were reinfected within 8 to 32 weeks after completion of therapy. We conclude that treatment with ciprofloxacin alone, although effective for the acute symptoms, is associated with an appreciable rate of relapse; therefore, it should be given with other agents for treatment of brucellosis.
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PMID:Efficacy of ciprofloxacin for treatment of Brucella melitensis infections. 159 Jun 81

The common infective conditions encountered at King Khalid Teaching Hospital, Riyadh, Saudi Arabia were described. These data were collected mostly during a period of 8 years between 1981 to 1988. These infections included brucellosis, cholecystitis, conjunctivitis, enteric fever, gastroenteritis, infective endocarditis, meningitis, otitis media, pneumonia, septicaemia, sorethroat, treponemal infections, urethritis, urinary tract infections, and vaginitis. A scheme for empiric chemotherapy has been suggested for these infections based on the sensitivity results obtained mostly from the microbiology laboratory at Teaching Hospital, Riyadh. This scheme of empiric therapy is offered as a guide only. It does not cover all possibilities and is not intended as a rigid dogma. Empiric therapy has also been suggested for some other infective conditions where sufficient data were not available from the Teaching Hospital. Empiric therapy should be started after relevant specimens are collected. Culture and sensitivity tests are invaluable in the management of patients with infectious diseases. As soon as sensitivities of the infecting organisms' are known, treatment should be adjusted accordingly. In some cases, Gram-staining is valuable to guide the initial therapy (eg. meningitis, pneumonia, and urethritis). Finally, close liaison between physicians and clinical microbiologists is mandatory for successful therapy.
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PMID:Empiric therapy of common bacterial infections in Saudi Arabia; a review. 161 94

Two hundred and seventy patients were studied during a 2 years period in Abbassia and Embaba fever hospitals. The duration of illness before admission was less than 20 days. Suggestive clinical symptoms and/or signs of each disease were stressed. Rapid laboratory investigations include slide typhoid agglutination test (98%) in enteric fevers, slide malta agglutination test (86%) in brucellosis, urine culture (100%) in urinary tract infection, gram stain of C.S.F. in bacterial meningitis (80%), encephalitis (0%) and meningeal irritation (0%), high vaginal swab culture (100%) in puerperal fevers, echocardiogram (100%) in infective endocarditis, high E.S.R. (100%) and positive C.R.P. (71%) and/or high A.S.O. (86%) in rheumatic fever, counterimmunoelectrophoresis (86%) in amoebic liver abscess, chest X-ray in pneumonia (100%), pulmonary tuberculosis (100%) and pleural effusion (100%), ultrasound of lymph nodes (100%) in tuberculous lymphadenitis. Erysipelas and tetanus were diagnosed on clinical grounds only.
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PMID:Rapid diagnosis of non-prolonged febrile illnesses necessitating fever hospital admission. 179 71

Three patients, 2 with congenital valvular heart disease and 1 with a prosthetic aortic valve developed brucellosis. Brucella melitensis was isolated from blood of all 3 patients. The clinical and microbiological features suggested Brucella endocarditis and following successful antibiotic therapy, no surgery was required. The salient diagnostic features are discussed with emphasis on the management and prognosis of patients with Brucella endocarditis.
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PMID:Brucellosis in patients with heart disease: when should endocarditis be diagnosed? 207 47

A study was made of 92 bacteremia episodes among patients admitted to the Ivrea-Castellamonte Hospital (Turin, Italy) between June 1986 and September 1989. A single microorganism was isolated in 84 episodes (91.3%), the most common being: Staphylococcus aureus (21.7%), Escherichia coli (18.5%), Enterococcus (9.8%), Pseudomonas aeruginosa (6.5%), and Proteus mirabilis (5.4%). The episodes were of both hospital and community origin: 54.3% vs. 45.7%. Their main sources were: the urinary tract (16.3%), abdominal infections (14.2%), endocarditis (7.6%), and the respiratory tract (5.5%). No source could be identified in 26%. Brucellosis, salmonellosis and listeriosis together constituted 8.7% of the episodes. Abdominal infections were primarily responsible for the 8 cases (8.7%) of polymicrobial bacteremia. The overall mortality was 18.5% (6.5% community vs. 12% hospital episodes). Mortality directly due to bacteremia was 8.7%. Bacteremia was the direct or indirect cause of death in 22.6% of patients greater than or equal to 65, compared with 19% and 10% in those aged 35-64 and 15-44 respectively. The patient's clinical picture at the time of infection was a prognostic factor: mortality was much lower in subjects previously healthy or free from basic diseases (11.8%) than in those with non-rapidly-fatal diseases (21.7%) or rapidly-fatal diseases (54.5%). Bacteremia-linked mortality (direct and indirect) was higher in Gram-positive vs Gram-negative infections: 22.2% vs 15.8%. Mortality was 12.5% in the group of patients with polymicrobial infections.
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PMID:[Community- and hospital-acquired bacteremia: a retrospective study in a regional hospital. II. Clinical observations]. 213 29

The effectiveness of treating human brucellosis caused by Brucella melitensis with a 6-week course of doxcycline plus streptomycin for 2 of those weeks was analyzed by a multicenter prospective study of 139 patients. Subjects with central nervous system involvement, endocarditis, or spondylitis were excluded from the study. All but 5 of the 139 patients completed the full treatment schedule and became afebrile in the first week of therapy. Four patients suffered relapses during the follow-up period. Of the five patients who did not complete the treatment, two left because of adverse secondary effects (1.4%), another two left for noncomplicance with the treatment (1.4%), and the remaining patient was considered a therapeutic failure because his symptoms persisted after the first week of therapy (0.7%). We concluded that the combination of doxycycline and streptomycin is an effective treatment for the types of brucellosis included in our study.
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PMID:Multicenter prospective study of treatment of Brucella melitensis brucellosis with doxycycline for 6 weeks plus streptomycin for 2 weeks. 219 24

Brucella endocarditis, although a rare complication of brucellosis, is the main cause of death related to this disease. This report describes a case of aortic endocarditis due to Brucella abortus in an elderly farmer with known aortic stenosis. Urgent valve replacement was performed because of progressive heart failure despite appropriate antimicrobial treatment. The infection was cured with trimethoprim-sulfamethoxazole and rifampin given for 3 months after surgery. A review of the literature reports on the 38 other cases of cured brucella endocarditis made clear the need for combined antimicrobial treatment and surgical valve replacement.
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PMID:Brucella endocarditis: the role of combined medical and surgical treatment. 223 11


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