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

The authors report the case of a 22 year old patient with brucella endocarditis on a Starr-Edwards aortic valve prosthesis implanted 5 years previously. Six blood cultures were positive for Brucella melitensis biovar I. Antibiotic therapy associating Rifampicin and Tetracycline and then Rifampicin and Ofloxacine did not prevent abscess formation and valve dehiscence. The poor haemodynamic status and persistent infection led to replacement of the valve prosthesis. Culture of the infected prosthesis grew a colony of brucella melitensis resistant to fluoro-quinolones. Valve replacement and antibiotic therapy led to clinical improvement and constant apyrexia with a 12 month follow-up. Brucella endocarditis on a valve prosthesis is a very rare occurrence. The combination of valve replacement and antibiotic therapy is usually required.
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PMID:[Brucella endocarditis on Starr aortic valve prosthesis]. 202 Dec 91

More than 300 commencial bacterial species may be found in the oral cavity. Other microorganisms, such as mycoplasms, mycetes, protozoa and viruses are present as well. The virulency of the saprofites and additional contamination by outside microorganisms are factors determining the development of infectious process in the oral tissues. Moreover, streptococci and anaerobes are the most frequent aetiology agents. The antibiotic therapy should comply with the general treatment criteria, on the one hand, and should be specific for these microorganism, on the other. The penicillines (ampicillin, bacampicillin and especially amoxycillin) process pharmacokinetic properties which make them a favorable choice for treatment. These drugs are effective in case of streptococcal infections, with cariogenic processes involvement and dissemination (endocarditis, glomerulonephritis). Other, frequently used drugs are spiramycin, erythromycin, josamycin and myocamycin that are selectively taken up by the oral tissues and present in large quantities in the saliva. The macrolides have a large spectrum of action on microorganisms normally found in the oral cavity. Lincosamides (lincomycin and clindamycin) are active on anaerobes and are drugs of choice for treatment of staphylococcal osteomyelitis. Tetracycline therapy is restricted usually to parodontite cases caused by Actinobacillus actinomycetemcomitans and Capnocytophaga. In conclusion, the choice of antibacterial therapy should be based on the bacterial aetiology, as well as on the intrinsic drug characteristics (pharmacokinetic, side effects, toxicity etc.).
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PMID:[Antibiotic therapy of bacterial infections of the oral cavity]. 263 55

In order to assess the species distribution and the antibiotic susceptibility of viridans streptococci in various human infections, we reviewed 164 cases of viridans streptococcal bacteremia seen at the National Taiwan University Hospital between May 1981 and April 1987. The organisms were isolated from 83 patients with endocarditis. Among 81 nonendocarditis patients, only 54 had clinically recognizable foci of suppurative inflammation. Mainly based on API 20 STREP system of species identification, S. sanguis II accounted for 24.4%; S. mitis, 20.7%; S. sanguis I, 20.1%; and S. milleri 2, 11.6% of the 164 cases studied. Of 83 endocarditis patients, 27.7% were S. sanguis I; 21.7%, S. sanguis II; and 16.9%, S. mitis. In nonendocarditis bacteremia with known suppurative lesions, 3 most often isolated organisms were S. sanguis II (24.0%), S. mitis (24.0%), and S. milleri 2 (24.0%). In nonendocarditis bacteremia without suppurative infection, the most frequent isolates were S. sanguis II (33.3%) and S. mitis (25.9%). In terms of relative frequency between endocarditis and nonendocarditis cases, S. mutan, S. sanguis I, and S. bovis had the highest frequency ratio of 7:1, 3.5:1, and 1.5:1, respectively. All isolates were susceptible to penicillin G, ampicillin, and cephalothin. Tetracycline resistance, however, were observed in 35.4% of the isolates; oxacillin resistance, 11.0%; and erythromycin resistance, 9.1%.
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PMID:Bacteriology of viridans streptococcal bacteremia. 344 20

Despite a worldwide distribution of Coxiella burnetii, only single cases of Q fever endocarditis have been reported outside Great Britain and Australia. We present 10 patients; five were female, only four had a history of environmental exposure, and the mitral valve was involved as commonly as the aortic stenosis, and three patients had a prosthetic valve. We confirm the importance of hepatic involvement, thrombocytopenia and hypergammaglobulinemia as diagnostic features. Diagnosis was established by finding and elevated complement-fixing antibody to Phase I C. burnetii antigen. Tetracycline, with or without lincomycin or cotrimoxazole, was used in nine patients, and one patient received cotrimoxazole as as the sole antibiotic agent. Optimal duration of therapy is unknown. In one patient, relapse followed when treatment was stopped after 18 months. Valve replacement was necessary in five patients, because of hemodynamic problems. Five patients died, and the means survival is 36 months with a range of five to 66 months. We suggest that Q fever endocarditis is frequently missed, and we recommend clinicians to consider the diagnosis in all cases of culture-negative endocarditis.
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PMID:Q fever endocarditis. 697 71

The microflora associated with odontogenic infections are typically mixed and of indigenous origin. Streptococcus, peptostreptococcus, peptococcus, fusobacterium, bacteroides, and actinomyces species are the principle microflora isolated from these infections. Penicillin V (phenoxymethyl penicillin) remains the antimicrobial of choice for the initial empirical treatment of odontogenic infections. This agent is safe, highly effective and inexpensive. Amoxicillin has little indication for the routine treatment of odontogenic infections. However, it is the agent of choice for endocarditis prophylaxis, as it produces higher serum levels than penicillin V. Erythromycin may be used for mild, acute odontogenic infections in penicillin-allergic patients. The high incidence of gastrointestinal disturbances and superinfection commonly associated with the ingestion of tetracycline limits its role in general dental practice. Tetracycline may be considered as an alternative therapy for penicillin-allergic patients over the age of 13 who cannot tolerate erythromycin. Clindamycin is very effective against all odontogenic pathogens, but its potential gastrointestinal toxicity relegates it to third- or even fourth-line therapy in general dentistry. Although metronidazole displays excellent activity against anaerobic gram-negative bacilli, it is only moderately effective against facultative and anaerobic gram-positive cocci, and should not be used alone in the treatment of acute odontogenic infections.
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PMID:A review of commonly prescribed oral antibiotics in general dentistry. 845 30

Brucellosis is an extremely important disease around the world, especially in developing countries. Its clinical manifestations and severity vary with the patient population studied and the species of Brucella involved. The choice of regimen and duration of antimicrobial therapy should be based on whether focal disease is present or there are underlying conditions that contraindicate certain antibiotics (e.g. pregnant patients or children under 8 years old). Most individuals with acute brucellosis respond well to a combination of doxycycline plus aminoglycosides or rifampicin for 6 weeks. Monotherapy with doxycycline or minocycline, or a combination of doxycycline plus trimethoprim-sulfamethoxazole, or a quinolone plus rifampicin may be an alternative. Patients with focal disease, such as spondylitis or endocarditis, may require longer courses of antibiotics, depending on clinical evolution. Tetracycline monotherapy, especially with doxycycline, is a good option for patients with brucellosis with no focal lesions and a low risk of relapse. In this clinical situation, practitioners should avoid the use of high-cost or more toxic schedules.
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PMID:Update on brucellosis: therapeutic challenges. 2069 27