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August 4, 1989

Antibiotics in Endocarditis due to Nutritionally Deficient Streptococci

JAMA. 1989;262(5):618. doi:10.1001/jama.1989.03430050028020

To the Editor.—  Recently, the American Heart Association's Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease1 gave their recommendations for the treatment of streptococcal endocarditis, including that caused by nutritionally deficient variants. We feel their recommendation of 4 weeks of intravenous penicillin with at least 2 weeks of an aminoglycoside for treatment of endocarditis caused by nutritionally deficient variants deserves comment.Previous studies2-4 have demonstrated the isolation of penicillin-resistant strains5 and that minimal inhibitory concentrations to penicillin of 0.12 μg/mL or greater occur in up to one third of the strains tested. In clinical use, the therapy of penicillin and an aminoglycoside for nutritionally deficient streptococcal endocarditis has resulted in persistently positive blood cultures or positivevalue culture in 38% of the cases reviewed,5 as compared with the 25% failure rate noted in enterococcal endocarditis.1 Mortality in patients with nutritionally deficient streptococcal endocarditis who received penicillin