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Thank you for your letter regarding our case report (136:480-483, 1976). I agree that emboli can cause fever and can occur after institution of adequate antibiotic treatment. Nevertheless, persisting fever and embolization are also signs of active infection. Failure to obtain positive blood cultures after initiation of antibiotics does not indicate sterilization of the vegetation on the valve. The addition of treatment with gentamicin sulfate in our patient resulted in clinical improvement, as well as simultaneous improvement in the bacterocidal activity of the serum. In our experience at the Johns Hopkins Hospital, minimum inhibitory concentrations and minimum bacterocidal concentrations of methicillin for Staphylococcus aureus are usually not the same. We usually have found it more difficult to achieve an adequate bacteriocidal concentration. The difference may be due to variations in inoculum size, media, or other factors.Recently, experimental data, which are cited in our report, indicate the importance
Mann JJ. Treatment of Staphylococcus aureus Endocarditis-Reply. Arch Intern Med. 1977;137(3):401. doi:10.1001/archinte.1977.03630150094030
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