Antibiotics in Endocarditis due to Nutritionally Deficient Streptococci

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 studies^2-4 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