![]() 2Īnimal models of endocarditis demonstrated that penicillin and streptomycin in combination was more effective than penicillin alone in fully susceptible as well as penicillin-tolerant and -resistant (MIC 1.0 mg/L) strains. 4 As aminoglycosides act synergically with penicillin in vitro, it was logical to add these agents in order to try and reduce the duration of treatment. Early clinical studies found that when a total dose of 14–16 million units (8.75–10 g) of penicillin was given alone for 10–14 days, a relapse rate of 15% was encountered, but this fell to 0.6–1.3% with 4 weeks of therapy. Viridans streptococci and Streptococcus bovisĮndocarditis due to susceptible isolates responds well to antimicrobial chemotherapy. This article explores the laboratory and clinical evidence base for the treatment regimens advised and areas where once daily dosing of aminoglycosides may be implemented. ![]() 1, 2 Although these guidelines are broadly similar, 3 significant differences are apparent particularly with regard to the use of aminoglycosides (see Table ). ![]() Recommendations have recently been published by the British Society for Antimicrobial Chemotherapy (BSAC) and the American Heart Association (AHA) regarding the treatment of bacterial endocarditis. ![]()
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