Improving survival in bacterial endocarditis

Twenty six cases of bacterial endocarditis in infancy and childhood were treated with a mortality of less than 8%. Twenty two had recognised congenital heart disease and four had previously normal hearts. Thirteen out of the 24 cases with positive blood cultures had staphylococcal infection. Appropriate antibiotics were identified by measurement of the minimum bactericidal concentration as an indicator of antibiotic sensitivity. The bactericidal activity of the patient's serum during treatment was monitored by back titration against the causative organism to assess the optimal antibiotic combination and dosage. Treatment was continued for six weeks in most cases, comprising intravenous treatment for at least the first three weeks, but then being substituted with oral treatment in some. Twenty one cases were successfully treated medically. Five developed complications requiring surgery, two of whom died.