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

Seventy-six strains of various species of streptococci isolated from patients with infective endocarditis were tested for their susceptibility to 13 antibiotics by an agar dilution method. The antibiotics tested were: benzyl-penicillin, ampicillin, cefotaxime, vancomycin, erythromycin, rifampicin, pristinamycin, gentamicin, netilmicin, tobramycin, amikacin, dibekacin and streptomycin. Excluding enterococci, 91% of strains were sensitive to benzylpenicillin. Resistance to benzylpenicillin was only found in some strains of S. sanguis I, S. sanguis II and S. mitis. Enterococci were more sensitive to ampicillin. Cefotaxime was highly active against all strains, except enterococci. Vancomycin was active against all strains. Resistance to erythromycin was found in 16% of isolates. Rifampicin and pristinamycin were highly active against all strains, except some enterococci. Gentamicin and netilmicin were the most active of the six aminoglycosides tested. High level resistance to streptomycin was seen in six strains. Overall, S. agalactiae was more resistant to the aminoglycosides than the other species. Among the non-groupable streptococci, strains of S. mitis, S. sanguis I and S. sanguis II were the least sensitive to many antibiotics. Benzylpenicillin remains the antibiotic of choice for the treatment of IE caused by streptococci. If the MIC exceeds 0.1 mg l-1, an aminoglycoside (netilmicin or gentamicin) should be added and the duration of treatment increased from 4 to 6 weeks.
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PMID:Antibiotic susceptibility of streptococcal strains associated with infective endocarditis. 639 32

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

Actinobacillus actinomycetemcomitans is a gram-negative coccobacillus which is a very rare cause of bacterial endocarditis. Preexisting cardiac lesions are a main contributing factor, and antibiotic prophylaxis has long been felt necessary before dental or other manipulation to prevent endocarditis. Penicillin in combination with an aminoglycoside has been the most often used treatment regimen. We present a case of endocarditis caused by this organism which developed after antibiotic prophylaxis for dental cleaning. Streptomycin and rifampin therapy resulted in the cure of the infection. The treatment and epidemiology of Actinobacillus endocarditis are reviewed.
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PMID:Endocarditis caused by Actinobacillus actinomycetemcomitans. 649 Aug 39

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

In a retrospective study covering the years 1977 to 1981, the results of antibiotic treatment in 123 patients with staphylococcal septicaemia with or without endocarditis have been analysed. 80 patients (mean age 60 years) were non-drug addicts (Group I) and 43 (mean age 28 years) were drug addicts (Group II). Underlying conditions other than drug abuse were noted in 74 patients in Group I and in only 7 in Group II.S. aureus was isolated from 117 patients and S. epidermidis in 6, all of them in Group I. 91 strains were penicillinase producers, but all susceptible to isoxazolyl-penicillins. In Group I verified or highly suspected endocarditis was registered in 12 patients (15%), always left-sided, as against in 31 (72%) in Group II, of whom 25 had tricuspid valve engagement. In the multivariate pattern of antibiotic treatment 3 groups may be discerned; 1) Cloxacillin, alone (35 patients) or in a combination (57), 2) Penicillin G, alone (6) or in a combination (12), and 3) Lincomycin or clindamycin, a cephalosporin or co-trimoxazole, alone (4) or in combination (9). Additive agents were mostly an aminoglycoside or fusidic acid. Out of the 45 patients in the whole material who received single therapy 9 patients (20%) died, and out of the 78 patients who received combined therapy 13 patients (16.6%) died. In the cloxacillin group 11.8% died, compared to 35% who initially received other antibiotics. In 70 patients the initial therapy had to be changed, in 39 due to adverse drug reactions and in 31 due to therapeutic failures or for unexplained reasons. In these cases linco- or clindamycin, more rarely rifampicin or vancomycin, were used. In Group I, 20 patients (25%) died, 8 of them with endocarditis. Sequels, relapses or reinfections were noted in 21 (25%), and 39 (50%) had an uneventful course. In Group II, 2 patients (5%) died, both with endocarditis. Sequels, relapses or reinfections occurred in 11 (25%), and 30 (70%) had an uneventful course. From this unstructured material no definite conclusions can be drawn. However, the lower mortality rate in the cloxacillin group suggests this regimen to be superior. The addition of other antibiotics did not appear to influence the clinical outcome. There was a more favourable outcome in addicts than in non-addicts, despite the same general principles of antibiotic treatment. Thus, for the outcome the characteristics of the patient group seemed to have more influence than the choice of antibiotic treatment.
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PMID:Antibiotic treatment of staphylococcal septicaemia and endocarditis in a Swedish hospital. 658 54

A case of acute aortic valve Erysipelothrix rhusiopathiae endocarditis is reported in a 48 year old fisherman with no history of initial erysipelar and requiring emergency aortic valve replacement 48 hours after starting antibiotic therapy with Ampicillin and Gentamicin. The outcome was favourable. In the light of 32 of the 40 previously published cases, the authors discuss the difficulty in identifying the causal organism, the main epidemiological features, the occupational association of these infections, the incidence of primary infections, the involvement of the aortic valve and the more serious nature of the disease compared to non-D streptococcal endocarditis, despite high sensitivity to Penicillin G.
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PMID:[Erysipelothrix rhusiopathiae endocarditis. A case report and review of the literature]. 668 53

Minimal concentrations of aminoglycoside that could produce a synergistic effect with penicillin were investigated in broth cultures containing 10(8) enterococci per ml, in vitro in vegetations infected with ca. 10(8) enterococci per g, and in vivo in an experimental model of enterococcal endocarditis. Penicillin G plus gentamicin (1.5 or 0.75 microgram/ml) sterilized a broth culture of a streptomycin-resistant strain (E1) at 48 h. In contrast, penicillin G plus gentamicin (1.5 or 0.75 microgram/ml) sterilized only 2 of 15 in vitro vegetations at 5 days. Similarly, doses of gentamicin that resulted in peak serum levels of 1.5 microgram/ml failed after 10 days of therapy with penicillin G plus gentamicin to sterilize in vivo vegetations infected with E1, and doses of gentamicin that resulted in peak serum levels of about 8 micrograms/ml sterilized four of six vegetations. Similar results were obtained with a streptomycin-susceptible strain. These studies indicated that the rate of bactericidal activity in broth cultures is greater than the bacteriological response in infected vegetations and that aminoglycoside concentrations that appear efficacious on the basis of synergy studies in broth cultures may not be satisfactory clinically.
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PMID:Minimal concentrations of aminoglycoside that can synergize with penicillin in enterococcal endocarditis. 679 89

The effect of penicillin treatment of Streptococcus sanguis in vitro, on subsequent bacterial density in the bloodstream and on cardiac valves in the rabbit model of endocarditis was studied. As experimental tools for this study, isogenic pairs of S. sanguis differing in resistance to streptomycin or rifampin were prepared by genetic transformation. Rabbits with traumatized heart valves received an intravenous inoculation of penicillin treated (1 mug/ml) and untreated S. sanguis, each marked by resistance to either streptomycin or rifampin. The number of penicillin-treated and untreated bacteria attached to the valvular surfaces was determined by differential counting on streptomycin or rifampin containing media. Penicillin pretreatment reduced cardiac valve colonization 5 min after inoculation ("adherence ratio" x 10(8) was 4.11 for the control and 3.66 for the penicillin-treated bacteria, P < 0.001). The results were not due to differences in serum killing or bacterial densities in the bloodstream. There was no difference in valvular bacterial densities 24 h after bacterial inoculation (adherence ratio x 10(8), 7.26 untreated vs. 6.34 penicillin-pretreated, P > 0.10). In vitro experiments were performed using platelet-fibrin surfaces to test the possibility that penicillin-induced loss of lipoteichoic acid was responsible for decreased streptococcal adherence. Pretreatment of S. sanguis cultures with inhibitory concentrations of penicillin or with antiserum against lipoteichoic acid and precoating of the platelet-fibrin surfaces with lipoteichoic acid, all caused reduction in bacterial adherence. The findings are interpreted as support for the role of lipoteichoic acid as an adhesin in S. sanguis interactions with particular host tissue surfaces.
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PMID:Effect of penicillin on the adherence of Streptococcus sanguis in vitro and in the rabbit model of endocarditis. 682 29

140 cases of patients requiring sternotomy incisions were divided into two groups receiving Penicillin/Flucloxacillin and Cefamandole prophylaxis. Pre- and post-operative and bypass circuit bacteriology was performed to determine the extent of contamination and infection with each regime after operations lasting 7 or more hours. Unexpectedly high contamination of the respiratory tract was observed in patients receiving Penicillin/Flucloxacillin prophylaxis. Significantly higher Slesser Intensive Therapy Unit stays were observed in 8 of these patients, 3 of whom succumbed to chest infection associated pathology. The 50% resistant organism rate in the Cefa group (Table IV) suggests that short sharp course prophylaxis (i.e. less than 48 hours) using wide spectrum antibiotics is effective and does not necessarily promote emergence of resistant organisms over or above that of any narrow spectrum antibiotic prophylaxis. Acceptably low wound infection rates in both groups suggests that wound healing (aided by iodine sprays topically before closure) is more dependent on closing technique than on type of antibiotic prophylaxis. The very similar bacteriaemia rates, with odd organisms, in both groups in the immediate post-operative period suggests that vigilance and frequent post-operative blood cultures are a surer policy in the prevention and treatment of early endocarditis than faith in any particular antibiotic prophylaxis.
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PMID:Cefamandole as a prophylactic in cardiac surgery. 701 May 36

Endocarditis in a 2-year-old child was caused by a penicillin-resistant Streptococcus constellatus. Viridans streptococci in general and those associated with endocarditis in particular are usually believed to be penicillin sensitive. Although the patient did not receive prophylactic antibiotics, the child had recently been treated with an oral penicillin. Penicillin-resistant viridans streptococci are usually sensitive to the synergistic effects of penicillin and an aminoglycoside, but this organism was not. Clindamycin was ultimately shown to demonstrate admirable bactericidal activity against this patient's S constellatus.
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PMID:Penicillin-resistant Streptococcus constellatus as a cause of endocarditis. 705 9


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