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Short-term intramuscular therapy with procaine penicillin plus streptomycin for infective endocarditis due to
Abstract:
Thirty-three patients with viridans streptococcal infective endocarditis were treated for two weeks with intramuscular procaine pencillin, 1.2 million units every 6 hours, plus streptomycin, 500 mg intramuscularly every 12 hours. Nine patients (27%) had infections with relatively penicillin-resistant microorganisms (MIC greater than 0.1 microgram/ml or MBC greater than or equal 3.12 microgram/ml). Follow-up ranged from 2 months to 3.5 years. There were no relapses; Mild vestibular toxicity developed in one patient. One patient died two months after completion of antimicrobial therapy from sudden onset of severe congestive heart failure; Seven patients required cardiac valve replacement after completion of antimicrobial therapy. None died. We believe that this therapeutic regimen is effective antimicrobial therapy for infective endocarditis caused by viridans streptococci, irrespective of in vitro microbiologic data.
Insights
This study shows that a two-week treatment of procaine penicillin and streptomycin is effective for viridans streptococcal infective endocarditis. The regimen demonstrated no relapses, indicating a successful antimicrobial therapy approach.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Infective endocarditis (IE) caused by viridans streptococci is a serious condition.
- Treatment of IE requires effective antimicrobial strategies.
- Penicillin resistance can complicate treatment regimens.
Purpose of the Study:
- To evaluate the efficacy of a two-week intramuscular regimen of procaine penicillin and streptomycin for treating viridans streptococcal infective endocarditis.
- To assess treatment outcomes, including relapse rates, toxicity, and long-term survival.
Main Methods:
- A cohort of 33 patients with viridans streptococcal IE received intramuscular procaine penicillin (1.2 million units q6h) plus streptomycin (500 mg q12h) for two weeks.
- Patients were monitored for relapse, toxicity, and mortality.
- Follow-up duration ranged from 2 months to 3.5 years.
Main Results:
- Nine patients (27%) had infections with relatively penicillin-resistant strains (MIC > 0.1 µg/ml or MBC ≥ 3.12 µg/ml).
- No relapses of infective endocarditis were observed during the follow-up period.
- One patient experienced mild vestibular toxicity; another died from congestive heart failure unrelated to the infection; seven required valve replacement.
- No deaths were directly attributed to the infection post-treatment.
Conclusions:
- The combination of procaine penicillin and streptomycin for two weeks is an effective antimicrobial therapy for viridans streptococcal infective endocarditis.
- This regimen appears effective regardless of in vitro penicillin resistance data.
- The treatment offers a low relapse rate and acceptable toxicity profile.