To the Editor.—
Weinstein and Moellering1 recommend penicillin in combination with gentamicin instead ofstreptomycin for therapy of enterococcal endocarditis. This recommendation is based in part on our series2 that reported a 17% mortality rate in patients with enterococcal endocarditis treated with penicillin in combination with streptomycin. Weinstein and Moellering attributed our failures to inadequate antibiotic response. However, we clearly stated that none of the failures was related to failure of antibiotic therapy but to congestive heart failure, emboli, ruptured aneurysm, myocardial infarction, vasculitis, and even metastatic carcinoma occurring during therapy, often early in therapy. These complications (excluding carcinoma) are well known to occur in spite of control of infection. In fact, our results with enterococcal endocarditis treated with penicillin and streptomycin compare favorably with our results in nonenterococcal streptococcal endocarditis.3 The favorable results in our report and subsequent experience with enterococcal endocarditis is excellent evidence for recommending
Kaye D, Levison ME, Mandell GL, Hook EW. Penicillin-Gentamicin. JAMA. 1973;224(10):1426. doi:10.1001/jama.1973.03220240066025
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