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December 22, 1945

THE PENICILLIN TREATMENT OF SUBACUTE BACTERIAL ENDOCARDITISSOME PROBLEMS

Author Affiliations

SAN FRANCISCO

From the Department of Medicine, Stanford University School of Medicine.

JAMA. 1945;129(17):1135-1141. doi:10.1001/jama.1945.02860510001001
Abstract

That subacute streptococcic bacterial endocarditis can be "cured" by penicillin therapy now seems securely established.1 However, among the reported cases there are many in which apparent recovery—disappearance of toxic symptoms, fever and bacteremia—was soon followed by reappearance of organisms in the blood stream and resumption of a downhill course.2 Large statistics obtained under uniform conditions are not yet available, but in general recurrence seems to have taken place in one fourth to one half of the treated cases. It is important therefore to inquire into the reasons for failure in the hope of improving a method which has already yielded brilliant results in an otherwise uniformly fatal disease.

THE OPTIMUM DURATION OF TREATMENT  Assuming that one is dealing with a sensitive strain, the first question is that of the optimum time-dose relationships in the administration of penicillin. Over how long a period of time should penicillin be continued

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