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March 27, 1996

Antibiotic Treatment for Infective Endocarditis-Reply

Author Affiliations

for the Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease American Heart Association Dallas, Tex

JAMA. 1996;275(12):911. doi:10.1001/jama.1996.03530360021029

In Reply.  —We appreciate Dr Schwartz's comments. The gentamicin dosing schedule outlined in our article is intended as the initial dose. In any patient, gentamicin dosing should be adjusted after determining appropriate serum levels.Dr Johns and colleagues point out that in their opinion vancomycin trough levels are more valuable than peak levels for correlation with clinical responses. The study they cite,1 where a correlation between vancomycin serum concentration and outcome of patients with endocarditis was not observed, is retrospective, reports only 15 patients, and uses improperly timed specimens for the determination of peak concentration (30 minutes after infusion). We do not consider these data adequate to justify any recommendation regarding vancomycin dosing. In a more recent study from the same institution,2 vancomycin was administered in the treatment of Staphylococcus aureus endocarditis to achieve a median peak concentration (specimen drawn 30 minutes after infusion) of 34.5 μg/mL and