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Acute bacterial endocarditis due to Hemophilus parainfluenzae. Response to ceftizoxime in an ampicillin-allergic
C C da Camara1, B Weiner, J J Stetz
1Department of Pharmacy, Moses Cone Memorial Hospital, Greensboro, North Carolina.
Abstract:
Endocarditis secondary to Hemophilus parainfluenzae is an uncommon entity that appears to be increasing in frequency, perhaps due to improved laboratory isolation techniques. Although controversial, most of the published literature recommends a penicillin, with or without concomitant gentamicin, as definitive therapy. We report the first successful use of the third-generation cephalosporin ceftizoxime in an ampicillin-allergic patient. A 55-year-old white female was hospitalized after 5 days of experiencing fever, chills, nausea, and vomiting. A cardiac echocardiogram revealed a large mitral valve vegetation, and the patient was treated with intravenous ampicillin, gentamicin, and clindamycin. Two weeks after emergency mitral valve replacement the patient developed spiking fevers and a macular, erythematous rash while receiving ampicillin. Ceftizoxime was initiated and continued to complete a 4-week period of intravenous antibiotics. Follow-up at 14 months showed no further evidence of infection. Ceftizoxime appears efficacious in eradicating H. parainfluenzae in patients allergic to penicillin.
Insights
This study highlights the successful treatment of Hemophilus parainfluenzae endocarditis using ceftizoxime in a penicillin-allergic patient. This demonstrates ceftizoxime
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Endocarditis caused by Hemophilus parainfluenzae is rare but increasing.
- Penicillin-based therapies are standard but controversial.
- Alternative treatments are needed for allergic patients.
Observation:
- A 55-year-old female presented with symptoms of endocarditis.
- She developed a rash and fever while on ampicillin post-mitral valve replacement.
- Ceftizoxime was administered due to ampicillin allergy.
Findings:
- Ceftizoxime successfully eradicated H. parainfluenzae infection.
- The patient showed no signs of infection at 14-month follow-up.
- This marks the first reported successful use of ceftizoxime for this condition.
Implications:
- Ceftizoxime is a viable and effective alternative for penicillin-allergic patients with H. parainfluenzae endocarditis.
- Improved diagnostics may contribute to the rising incidence of this infection.
- Further research into cephalosporin efficacy in endocarditis is warranted.