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Antimicrobial Therapy for Two Serious Bacterial Infections: Enterococcal Endocarditis and Nosocomial Pneumonia

Antimicrobial Therapy for Two Serious Bacterial Infections: Enterococcal Endocarditis and... Abstract • Enterococcal endocarditis and gram-negative bacillary pneumonia are two serious infections that are particularly difficult to treat with currently available antimicrobial agents. Enterococcal endocarditis requires two drugs—a penicillin plus an aminoglycoside—to effect cure. Therapy for highly streptomycin-resistant strains seems to be particularly troublesome. The incidence of relapse and toxic reactions are high even when penicillin and gentamicin are administered for four weeks. New drugs that are less toxic are desperately needed. Nosocomial gram-negative bacillary pneumonia is associated with an extremely high mortality. However, overdiagnosis leads to the overuse of potentially toxic antimicrobial agents. Currently, therapy is usually initiated with a β-lactam drug and an aminoglycoside, and the incidence of toxic reactions is high. New therapeutic approaches are needed. (Arch Intern Med 1982;142:2033-2034) References 1. Sande MA: Prophylactic antibiotics during diagnostic procedures of the gastrointestinal tract , in Infective Endocarditis , an American Heart Association Symposium (Monograph No. 52). The American Heart Association, Inc, Dallas, 1977, pp 73-74. 2. Bartlett, Onderdonk AB, Louie T, et al: A review: Lessons from an animal model of intra-abdominal sepsis. Arch Surg 1978;113:853-862.Crossref 3. Hunter HT: The treatment of some bacterial infections of the heart and pericardium. Bull NY Acad Med 1952;28:213. 4. Hook EW III, Roberts RB, Sande MA: Antimicrobial therapy of experimental enterococcal endocarditis. Antimicrob Agents Chemother 1975;8:564-570.Crossref 5. Carrizosa J, Kaye D: Antibiotic synergism in enterococcal endocarditis. J Lab Clin Med 1976;88:132-141. 6. Mandell GL, Kaye D, Levison ME, et al: Enterococcal endocarditis: An analysis of 38 patients observed at the New York Hospital—Cornell Medical Center. Arch Intern Med 1970;125:258-264.Crossref 7. Moellering RC Jr, Wennersten C, Weinberg AN: Studies on antibiotic synergism against enterococci: I. Bacteriologic studies. J Lab Clin Med 1971;77:821. 8. Wilson WR, Wilkowski CJ, Thompson RL, et al: Treatment of streptomycin-resistant enterococcal infective endocarditis, abstracted. Read before the 19th Interscience Conference on Antimicrobial Agents and Chemotherapy, Boston, Oct 5, 1979. 9. Reynolds HY, Fick RB: Pseudomonas aeruginosa pulmonary infections (emphasizing nosocomial pneumonia and respiratory infections in cystic fibrosis) , in Sabath LD (ed): Pseudomonas aeruginosa. Bern, Switzerland, Hans Huber Publishers, 1980, pp 71-88. 10. Johanson, WG, Pierce AK, Sanford JP: Nosocomial respiratory infections with gram-negative bacilli: The significance of colonization of the respiratory tract. Ann Intern Med 1972;77:701-706.Crossref 11. Hawley HG, Lewis RM, Swartz DR, et al: Tobramycin therapy of pulmonary infections in patients with cystic fibrosis. Curr Ther Res 1974;16:414-423. 12. Gross PA, Neu HC, Van Antwerpen C, et al: Deaths from nosocomial infections: Experience in a university hospital and a community hospital. Am J Med 1980;68:219-223.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Antimicrobial Therapy for Two Serious Bacterial Infections: Enterococcal Endocarditis and Nosocomial Pneumonia

Archives of Internal Medicine , Volume 142 (11) – Oct 25, 1982

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340240055010
Publisher site
See Article on Publisher Site

Abstract

Abstract • Enterococcal endocarditis and gram-negative bacillary pneumonia are two serious infections that are particularly difficult to treat with currently available antimicrobial agents. Enterococcal endocarditis requires two drugs—a penicillin plus an aminoglycoside—to effect cure. Therapy for highly streptomycin-resistant strains seems to be particularly troublesome. The incidence of relapse and toxic reactions are high even when penicillin and gentamicin are administered for four weeks. New drugs that are less toxic are desperately needed. Nosocomial gram-negative bacillary pneumonia is associated with an extremely high mortality. However, overdiagnosis leads to the overuse of potentially toxic antimicrobial agents. Currently, therapy is usually initiated with a β-lactam drug and an aminoglycoside, and the incidence of toxic reactions is high. New therapeutic approaches are needed. (Arch Intern Med 1982;142:2033-2034) References 1. Sande MA: Prophylactic antibiotics during diagnostic procedures of the gastrointestinal tract , in Infective Endocarditis , an American Heart Association Symposium (Monograph No. 52). The American Heart Association, Inc, Dallas, 1977, pp 73-74. 2. Bartlett, Onderdonk AB, Louie T, et al: A review: Lessons from an animal model of intra-abdominal sepsis. Arch Surg 1978;113:853-862.Crossref 3. Hunter HT: The treatment of some bacterial infections of the heart and pericardium. Bull NY Acad Med 1952;28:213. 4. Hook EW III, Roberts RB, Sande MA: Antimicrobial therapy of experimental enterococcal endocarditis. Antimicrob Agents Chemother 1975;8:564-570.Crossref 5. Carrizosa J, Kaye D: Antibiotic synergism in enterococcal endocarditis. J Lab Clin Med 1976;88:132-141. 6. Mandell GL, Kaye D, Levison ME, et al: Enterococcal endocarditis: An analysis of 38 patients observed at the New York Hospital—Cornell Medical Center. Arch Intern Med 1970;125:258-264.Crossref 7. Moellering RC Jr, Wennersten C, Weinberg AN: Studies on antibiotic synergism against enterococci: I. Bacteriologic studies. J Lab Clin Med 1971;77:821. 8. Wilson WR, Wilkowski CJ, Thompson RL, et al: Treatment of streptomycin-resistant enterococcal infective endocarditis, abstracted. Read before the 19th Interscience Conference on Antimicrobial Agents and Chemotherapy, Boston, Oct 5, 1979. 9. Reynolds HY, Fick RB: Pseudomonas aeruginosa pulmonary infections (emphasizing nosocomial pneumonia and respiratory infections in cystic fibrosis) , in Sabath LD (ed): Pseudomonas aeruginosa. Bern, Switzerland, Hans Huber Publishers, 1980, pp 71-88. 10. Johanson, WG, Pierce AK, Sanford JP: Nosocomial respiratory infections with gram-negative bacilli: The significance of colonization of the respiratory tract. Ann Intern Med 1972;77:701-706.Crossref 11. Hawley HG, Lewis RM, Swartz DR, et al: Tobramycin therapy of pulmonary infections in patients with cystic fibrosis. Curr Ther Res 1974;16:414-423. 12. Gross PA, Neu HC, Van Antwerpen C, et al: Deaths from nosocomial infections: Experience in a university hospital and a community hospital. Am J Med 1980;68:219-223.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 25, 1982

References