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June 13, 1977

Cefazolin and Staphylococcus aureus Endocarditis

JAMA. 1977;237(24):2601. doi:10.1001/jama.1977.03270510023006

To the Editor.—  Bryant and Alford (237:569, 1977) suggest that cefazolin sodium should not be used for treatment of Staphylococcus aureus endocarditis. We disagree. Because of its long half-life (allowing less frequent administration), relative lack of pain on intramuscular injection, and very high blood levels, cefazolin is often the antibiotic used in treating patients with inadequate veins.It should be recognized that failure of therapy or relapse in cases of S aureus endocarditis is not infrequent with any antibiotic. We and others (G. C. Cobbs, personal communication)1 have seen patients with persistently positive blood cultures after one to two weeks of treatment with large doses of methicillin, nafcillin, oxacillin, cephalothin, or vancomycin. Some of these patients eventually respond to continuation of the same treatment, but therapy is usually altered.1 Slow responses and relapses may be related to abscesses in the spleen, heart, or other organs.How significant are