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March 20, 1978

Treatment of Staphylococcal Endocarditis

Author Affiliations

University of Oregon School of Medicine Health Sciences Center Portland
Veterans Administration Hospital Nashville, Tenn

JAMA. 1978;239(12):1130. doi:10.1001/jama.1978.03280390026004

To the Editor.—  We noted with interest the comments of Kaye, Hewitt, Remington, and Turck (237:2601,1977) concerning our article "Unsuccessful Treatment of Staphylococcal Endocarditis with Cefazolin" (237:569, 1977), describing two patients with staphylococcal endocarditis treated unsuccessfully with cefazolin.Prior to publication of our article, we reviewed the literature seeking criteria by which to judge our experience. We were amazed by what we found, or rather did not find. There was paucity of critical information on which to base selection of an antibiotic for therapy of Staphylococcus aureus endocarditis. We were soon struck by the lack of information about the relative effectiveness of the longer used drugs such as methicillin, oxacillin, or nafcillin and by even less information about the cephalosporins. We found no generally accepted technique for performing serum bactericidal titers. Though a bactericidal titer of 1:8 or greater has been associated with a favorable outcome in collected staphylococcal infections,