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

While Branhamella catarrhalis is now recognized as an important pathogen, this is only the fifth reported case of endocarditis caused by it. The production of beta-lactamase by many strains and its resistance to vancomycin and clindamycin complicate the choice of antibiotic therapy.
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PMID:Branhamella catarrhalis endocarditis in a patient receiving hemodialysis. 402 76

Aminoglycosides still play a major role int e treatment of severe infections, especially those due to Gram-negative bacilli. They are usually administered together with a beta-lactam antibiotic, either to cover a wide antibacterial spectrum, or to obtain a better bactericidal effect, or to prevent the emergence of resistant mutants. They are mainly used in severe urinary tract infections and/or in those due to multiresistant organisms and in Gram-negative pneumonia and meningitis (intrathecally, since they poorly diffuse into the CSF). Combined with cephalosporins they constitute the first-line treatment of severe, life-threatening infections caused by Gram-negative aerobes. Given simultaneously with penicillinase-resistant semi-synthetic penicillins or with vancomycin they act synergistically against staphylococci and can be used initially for a few days in the treatment of severe staphylococcal infections. It is also for this synergistic action that they are combined with penicillin G or ampicillin in the treatment of endocarditis. The ototoxic or nephrotoxic effects common to all aminoglycosides can be avoided by adjusting the doses to the degree of renal function, by limiting their use to about a fortnight (except for endocarditis) and by monitoring blood levels.
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PMID:[Current therapeutic indications of aminoglycosides]. 623 28

In the period 1975-1981, 4060 cases of Staphylococcus aureus bacteremia were recorded in Denmark, and the corresponding strains were examined. The percentage of strains, resistant to penicillin only, rose to 82, and the percentage of multiply-resistant strains fell to five. Newer phage types (94, 96 and 95) increased from 10% to 27% of the material. These strains were usually resistant only to penicillin, but produced large amounts of penicillinase. The ample penicillinase production has also been characteristic for previous epidemic strains, and it is furthermore correlated to mortality. The overall mortality of 34.6% was lower than that of the preceding period. Mortality rates were highest in elderly patients, nosocomial cases, patients with serious primary diseases and endocarditis cases.
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PMID:Frequency, phage types and antibiotic resistance of Staphylococcus aureus isolated from blood cultures in Denmark 1975-1981. 623 75

The efficacy of combined therapy with ampicillin and a beta-lactamase inhibitor, CP-45,899, for experimental endocarditis due to Staphylococcus aureus was evaluated. Three strains of beta-lactamase-producing S. aureus were used, and intramuscular doses of antibiotics were selected to produce serum levels in rabbits similar to those expected in humans. Sera from animals treated with ampicillin plus CP-45,899, but not from those treated with nafcillin plus gentamicin, had bactericidal activity against two nafcillin-resistant strains of S. aureus at 1 hr. The combination of ampicillin plus CP-45,899 was as effective as nafcillin in treatment of endocarditis due to one nafcillin-sensitive strain and was superior to nafcillin against two nafcillin-resistant strains (P less than 0.001). In a short-term treatment experiment using the nafcillin-sensitive strain, ampicillin plus CP-45,899 sterilized vegetations as rapidly as nafcillin plus gentamicin. Thus, ampicillin plus a beta-lactamase inhibitor may be effective treatment for bacteremic infections due to S. aureus, even when the strain is nafcillin-resistant.
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PMID:Efficacy of ampicillin plus a beta-lactamase inhibitor (CP-45,899) in experimental endocarditis due to Staphylococcus aureus. 626 15

Branhamella catarrhalis--a Gram-negative diplococcus--differs biochemically from other Neisseriaceae and possesses a specific protein with antigenic properties. Although scattered cases of meningitis and endocarditis have been reported since 1907, B. catarrhalis has been considered a non-pathogenic, pharyngeal commensal. However, relatively recent reports have shown B. catarrhalis to play a significant role in the etiology of otitis media and bronchopulmonary infections. Some reports also indicate a pathogenic role in sinusitis and longstanding cough in children, and in acute laryngitis in adults. B. catarrhalis is susceptible to co-trimoxazole, erythromycin, cephalosporins and tetracyclines. Most strains are also susceptible to penicillin, but the frequency of beta-lactamase producing B. catarrhalis has increased from 4% to 25% during the last six years (Sweden). First choice antibiotics in infections with penicillin-resistant strains would be erythromycin and co-trimoxazole.
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PMID:Pathogenicity of Branhamella catarrhalis. 633 74

10 patients with serious infections caused by Staphylococcus epidermidis (8 cases of endocarditis in non-prosthetic valves, 1 was complicated by osteomyelitis, 1 case of osteomyelitis, and 1 case of septicemia) are described. Clinical and microbiologic features were evaluated including antibiotic sensitivity and synergy studies, phage typing and biotyping. Endocarditis tended to affect the elderly population and the clinical manifestations were quite similar to those caused by Streptococcus viridans. Both patients with osteomyelitis had involvement of the cervical spine with excellent response to antibiotic therapy. The only patient with septicemia acquired via hyperalimentation had delayed clearance of the bacteremia but ultimately responded to intravenous antibiotics. Rifampicin was the most effective of all antibiotics tested. All isolates were sensitive to penicillinase-resistant penicillins and cephalosporins and over half were sensitive to penicillin. Full synergistic activity was demonstrated with cephalothin and nafcillin in combination with rifampicin, and rifampicin-vancomycin was partially synergistic against the majority of the strains. Five of 8 available isolates were non-phage typeable and no definite pattern was established for various types of infections. Four of the 8 isolates were classified as biotype SIIa, 2 biotype SIIc and 2 biotype SVh.
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PMID:Clinical and microbiologic aspects of serious infections caused by Staphylococcus epidermidis. 636 77

Mortality from pseudomonas infective endocarditis remains high despite optimal use of available antibacterial agents. Infection of the tricuspid valve is subacute, but involvement of the mitral or aortic valve precipitates more serious disease. Most valvular infections are due to a single pseudomonad immunotype, but 20% of cases are mixed infections. Antimicrobial susceptibility tests and tests of synergy by beta-lactam and aminoglycoside antibiotics in combination were performed on 30 isolates of Pseudomonas aeruginosa. Azlocillin was the most effective beta-lactam in combination with an aminoglycoside; MKO 787 was least effective. Among the aminoglycosides tested, netilmicin was the most effective. Medical treatment combined with valvulectomy (without valve replacement) is now standard treatment for refractory right-sided endocarditis at this medical center. A high dose of aminoglycoside in combination with a beta-lactam has proved efficacious. For left-sided infection, immediate valve replacement accompanied by a six-week course of the high dose-combined drug regimen is recommended. Newer beta-lactam antibiotics, such as piperacillin, may be limited in usefulness due to beta-lactamase inactivation.
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PMID:Current problems in the treatment of infective endocarditis due to Pseudomonas aeruginosa. 640 76

Despite the availability of numerous beta-lactam antibiotics, benzylpenicillin remains the most important beta-lactam antibiotic in the treatment of bacterial endocarditis. Penicillin alone and in combination with an aminoglycoside is effective in the treatment of endocarditis due to all streptococci, Streptococcus pneumoniae, penicillin-susceptible Staphylococcus aureus, Haemophilus aprophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Listeria monocytogenes. Oral phenoxymethylpenicillin in combination with streptomycin is effective in treating endocarditis due to viridans streptococci. Ampicillin is effective in endocarditis due to Haemophilus influenzae, H. parainfluenzae, H. paraphrophilus, Listeria monocytogenes and Escherichia coli. Oral amoxicillin with gentamicin has been used to treat enterococcal endocarditis. The penicillinase-resistant penicillins are effective in treating S. aureus endocarditis. Carbenicillin or ticarcillin in combination with tobramycin or gentamicin are used to treat endocarditis due to Serratia marcescens and Pseudomonas aeruginosa. The use of piperacillin in combination with tobramycin against P. aeruginosa endocarditis has been associated with failure and increased resistance. The cephalosporins have been used to treat endocarditis caused by susceptible organisms. There have been few data on the efficacy of the newer cephalosporins in treating endocarditis. They have been used to treat septicaemia due to susceptible organisms with good results.
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PMID:The use of beta-lactam antibiotics in the treatment of septicaemia and endocarditis. 644 9

A kinetic killing-curve method, designed to mimic several aspects of clinical therapy in endocarditis, was used to test 10 strains of Haemophilus parainfluenzae against 28 antibiotic regimens. In an effort to simulate changing in vivo levels of antibiotic in serum, concentrations of three penicillins, three cephalosporins, gentamicin, and chloramphenicol were sequentially adjusted over a 12-hr period. Against six beta-lactamase-negative strains, gentamicin in combination with penicillin or cephalosporin invariably resulted in an additive or synergistic effect. Chloramphenicol and a penicillin or cephalosporin usually displayed an indifferent effect, but chloramphenicol was often antagonistic when combined with gentamicin. With four beta-lactamase-positive strains, variable responses were noted to penicillin-aminoglycoside combinations; cephalosporin-aminoglycoside combinations were usually synergistic. This dynamic approach to killing-curve studies may be more appropriate than a static system for in vitro examination of the effect of antimicrobial combinations against selected organisms.
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PMID:Antimicrobial susceptibility testing of Haemophilus parainfluenzae by a kinetic killing-curve method. 644 77

Penicillin G administered parenterally or penicillin V administered orally are currently the antibiotics of choice for treatment of dental infections of usual etiology. Infections caused by penicillinase-producing staphylococci or those involving gram-negative bacteria should be treated with a penicillinase-resistant penicillin or an ampicillin-like derivative, respectively. Erythromycin is a second-choice bacteriostatic antibiotic, becoming first choice for treating dental infections in patients allergic to penicillin. The cephalosporins, similar in action to ampicillin-like penicillin derivatives, may be used with caution in patients who have exhibited delayed-type allergic reactions to penicillin and when erythromycin cannot be used. Their lack of advantage over other agents, and their cost, precludes routine use for usual dental infections. Clindamycin administered orally or lincomycin administered parenterally are reserve antibiotics indicated for treatment of bone infections and/or anaerobic infections refractory to commonly used antibiotics. Tetracyclines are, at best, third-choice agents for usual dental infections. However, they are useful for cases of acute necrotizing ulcerative gingivitis requiring systemic antibiotic therapy when penicillin is precluded. Vancomycin and streptomycin are used prophylactically for prevention of infective endocarditis in patients with prosthetic heart valves. Nystatin remains a first-choice agent for treatment of oral candidal infections. Ketoconazole, an orally active systemic antifungal agent, may be used for monilial infections of the oral cavity refractory to nystatin. Chemotherapy of viral infections is difficult because of the timing of events of the disease process versus appearance of clinical symptoms and lack of effective agents with selective toxicity. Herpes infections of the oral cavity have been treated--with limited success--with idoxuridine. Acyclovir, a newer antiviral drug, offers little clinical benefit for herpes infections in usually healthy patients but may be of value for treating such infections in immunocompromised patients. All antimicrobial agents may cause adverse reactions of varying degrees of severity. Most orally administered antibiotics may cause gastrointestinal disturbances. Superinfections occur with broad-spectrum antibiotics and a severe form of superinfection, antibiotic-associated colitis, has occurred with almost all antibiotics. Allergic reactions of all degrees of severity can occur with most antibiotics. The penicillins, followed by the cephalosporins and tetracyclines, are most frequently implicated in these reactions.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Use of antibiotics in dental practice. 658 79


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