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March 20, 1978

Treatment of Staphylococcal Endocarditis-Reply

Author Affiliations

The Medical College of Pennsylvania Philadelphia
UCLA School of Medicine Los Angeles
Stanford Medical Center Stanford, Calif
University of Washington School of Medicine Seattle

JAMA. 1978;239(12):1130-1131. doi:10.1001/jama.1978.03280390026005

Our intent in writing the LETTER TO THE EDITOR was to criticize Bryant and Alford's extrapolation from one patient with S aureus endocarditis who clearly relapsed after cefazolin therapy and one who was a very questionable failure to a general prohibition about use of this agent in S aureus endocarditis. We also questioned the validity of their second case and asked for studies of antibacterial activity in serum (usually considered standard procedure in managing endocarditis) to better evaluate their cases. These are not forthcoming in their answer to our letter. We also pointed out that S aureus endocarditis is a difficult disease to treat and that failures have been reported with every antistaphylococcal agent that has been evaluated. We certainly did not question the need to report both favorable and unfavorable results but only their interpretations.

In the preceding letter, Bryant and Alford point out that there is