The therapy of subacute bacterial endocarditis, prior to the advent of the new chemotherapeutic agents, was all but futile. According to Libman, spontaneous recoveries probably occurred in from 3 to 5 per cent of the cases. Kelson and White1 collected data on 66 cases treated intensively with sulfapyridine, and in 65 the course of the disease was not influenced by this therapy. Friedman, Hamburger and Katz2 suggested that continued deposition of new fibrin and platelets on the vegetations created an impenetrable barrier to the action of otherwise effective agents; they proposed that a patient with bacterial endocarditis be first subjected to treatment with an anticoagulant such as heparin. Kelson and White1 treated 7 patients with sulfapyridine and heparin. Only 3 patients were able to take heparin for more than a week, and in these there was a striking improvement. The first reports on the effect of penicillin
PENICILLIN IN SUBACUTE BACTERIAL ENDOCARDITIS. JAMA. 1945;128(16):1166–1167. doi:10.1001/jama.1945.02860330034012
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