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Group B streptococcal infective endocarditis.

R J Backes, W R Wilson, J E Geraci

    Archives of Internal Medicine
    |April 1, 1985
    PubMed
    Summary
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    Group B streptococcal endocarditis treatment showed high cure rates with penicillin and aminoglycosides. Vancomycin or cefazolin are alternatives for penicillin-intolerant patients, while clindamycin should be avoided.

    Area of Science:

    • Infectious Diseases
    • Cardiology
    • Pharmacology

    Background:

    • Group B Streptococcus (GBS) is a significant cause of endocarditis.
    • Optimal treatment strategies for GBS endocarditis require further investigation.

    Purpose of the Study:

    • To evaluate the efficacy of various antibiotic regimens for treating GBS endocarditis.
    • To assess the in vitro activity of antibiotics against GBS.

    Main Methods:

    • Retrospective case series of five patients treated at Mayo Clinic from 1970-1983.
    • Determination of minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) for penicillin and cefazolin.
    • Assessment of synergistic activity between penicillin and streptomycin in vitro.

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    Main Results:

    • Penicillin demonstrated low MIC and MBC values against GBS.
    • Cefazolin exhibited similar in vitro activity to penicillin.
    • Three patients showed synergistic activity between penicillin and streptomycin in vitro.
    • Four out of five patients achieved cure, with three treated using combination therapy (aminoglycoside with penicillin, ampicillin, or vancomycin).
    • Three patients experienced large systemic emboli, with one mortality due to brain-stem infarct.

    Conclusions:

    • Penicillin, alone or combined with an aminoglycoside, is an effective treatment for GBS endocarditis.
    • Cefazolin or vancomycin can be used for patients intolerant to penicillin.
    • Clindamycin should be avoided for endocarditis caused by clindamycin-tolerant GBS strains.