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

From 1970 to 1983, five patients with group B streptococcal endocarditis were treated at the Mayo Clinic, Rochester, Minn. The minimal inhibitory concentration and the minimal bactericidal concentration of penicillin were 0.09 microgram/mL or less and 1.56 micrograms/mL or less, respectively. The in vitro activity of cefazolin against group B streptococci was similar to that of penicillin. In three of the five cases, penicillin and streptomycin acted synergistically in vitro against group B streptococci. Four of the five patients were cured, three by use of an aminoglycoside combined with penicillin, ampicillin, or vancomycin. Three of the five patients had multiple large systemic emboli, and one of the three died of brain-stem infarct. Penicillin alone or in combination with an aminoglycoside is effective therapy for group B streptococcal endocarditis. Patients unable to tolerate penicillin may be treated with cefazolin or vancomycin. Clindamycin therapy should be avoided in patients with endocarditis caused by strains that are tolerant in vitro to clindamycin.
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PMID:Group B streptococcal infective endocarditis. 388 92

An 18-year-old man had an eventually fatal case of Peptococcus magnus endocarditis. Multiple emboli and continued valve destruction occurred during appropriate therapy. Penicillin therapy was associated with fever and neutropenia, thought to be due to an immunologic mechanism.
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PMID:Peptococcus magnus endocarditis. 397 58

Penicillin prophylaxis against experimental endocarditis due to a strain of Streptococcus intermedius isolated from a patient with endocarditis was studied in rats. The minimum bactericidal concentration of penicillin for this strain was more than 64 mg/l and was higher than the peak penicillin serum level obtained in rats 30 min after the iv injection of 60 mg/kg, and in man after an oral dose of 2 g of phenoxymethyl penicillin. Moreover timed kill curves performed in the presence of 64 mg/l of penicillin showed no decrease in the number of colony-forming units during the first 6 h of incubation and only a 95% decrease after 24 h. In addition, no bactericidal activity could be detected in the serum 30 min after penicillin injection, that is at the time of bacterial challenge. Using the minimum bacterial inoculum needed to produce endocarditis in 90% of control animals (ID90), penicillin successfully prevented endocarditis due to this strain. We conclude that penicillin may prevent streptococcal endocarditis by other mechanisms than bacterial killing.
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PMID:Successful prophylaxis of experimental streptococcal endocarditis with single doses of sublethal concentrations of penicillin. 398 Mar 32

Cefazolin sodium was tested in vitro against 308 isolates of Enterobacteriaceae, Pseudomonas aeruginosa, Neisseria meningitidis, Haemophilus influenzae, Staphylococcus aureus, and enterococcus. Broth and agar dilution and disk diffusion techniques were used with at least two sizes of inocula of organisms. Cefazolin was also studied in the treatment of 85 hospitalized patients with a variety of serious infections. In concentations of 5 mug or less/ml, cefazolin inhibited and killed more than 90% of isolates of Enterobacteriaceae with the exception of indole-positive Proteus and Enterobacter species. No isolate of P. aeruginosa and only a few of Enterobacter and enterococci were killed by 25 mug of cefazolin/ml, a concentration readily attainable in serum with a 500-mg dose given intramuscularly. Penicillin-susceptible as well as penicillin-resistant isolates of S. aureus were killed by 1 mug or less of cefazolin per ml; however, 25 mug/ml was required to kill 100% of the strains when the inoculum size was increased 100-fold. Cefazolin treatment appeared effective in 82 of 85 patients, including four with endocarditis. Pain was minimal after intramuscular injection, and thrombophlebitis was not observed in those treated intravenously. No patient developed a positive Coombs test, and no evidence of renal toxicity was apparent in clinical studies.
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PMID:Evaluation of cefazolin, a new cephalosporin antibiotic. 479 Jun 5

Penicillin made possible the cure of many common, and also the most serious, infections, such as meningococcal meningitis and bacterial endocarditis, often with few or no sequelae. Endocarditis had been invariably fatal. Semisynthetic penicillins added new dimensions of convenience of administration and a broader spectrum in the presence of many beta-lactamases. A quantum step forward was permitted by the derivatives of cephalosporin C. Specific clinical advances were (1) the opportunity to use these in some penicillin-allergic patients, (2) activity against wider range of Gram-negative bacilli, (3) activity against Bacteroides fragilis (cefoxitin), (4) more complete renal excretion after oral cephalosporins than with oral penicillins, and (5) delayed renal excretion. Major remaining problems limiting beta-lactam use are (1) allergy, (2) resistant organisms, (3) relatively poor entry into the cerebrospinal fluid (especially of cephalosporins, (4) some nephrotoxicity, (5) local irritation of veins and tissues during administration, and (6) poor results in patients with agranulocytosis.
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PMID:Achievements and problems from the view of a physician. 610 21

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

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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