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Endocarditis treated with clindamycin: relapse and liver dysfunction
Abstract:
Clindamycin was used to treat six patients with endocarditis because of allergy to penicillin in five, and an unfavorable clinical response to methicillin in one. Only one patient had an uneventful cure with clindamycin. Two had hepatotoxicity which resolved rapidly after clindamycin was stopped. Two patients, one of whom had an aortic prosthesis, had completed four to six weeks of clindamycin therapy when clinical relapse occurred and blood cultures were again positive for a clindamycin-sensitive isolate. A fifth patient had peptostreptococcal endocarditis. Despite a favorable initial clinical and bacteriologic response, blood cultures taken on the 20th day of therapy again grew the Peptostreptococcus. This relapse pathogen had become resistant to clindamycin and was 100-fold less sensitive than the initial isolate. The few conditions in which clindamycin is indicated for therapy of bacterial endocarditis are outlined.
Insights
Clindamycin treatment for endocarditis showed limited success, with frequent relapses and resistance development. This highlights the need for careful consideration of clindamycin
Area of Science:
- Infectious Diseases
- Pharmacology
- Cardiology
Background:
- Bacterial endocarditis is a serious infection requiring effective antibiotic therapy.
- Clindamycin is sometimes used for endocarditis, particularly in penicillin-allergic patients.
Purpose of the Study:
- To evaluate the efficacy and safety of clindamycin in treating bacterial endocarditis.
Main Methods:
- Retrospective case series of six patients treated with clindamycin for endocarditis.
- Clinical outcomes, including cure rates, relapse, and adverse events, were assessed.
Main Results:
- Only one of six patients achieved an uneventful cure.
- Two patients experienced hepatotoxicity, which resolved after drug discontinuation.
- Two patients relapsed despite completing therapy, with one developing clindamycin resistance.
Conclusions:
- Clindamycin demonstrates limited efficacy for bacterial endocarditis due to high rates of relapse and resistance.
- Hepatotoxicity is a potential adverse effect.
- The indications for clindamycin in endocarditis therapy are narrow and require careful patient selection.