The Selection of Antibiotics in the Treatment of Subacute Bacterial Endocarditis

• Published in: Kansenshogaku Zasshi Vol. 45; no. 4; pp. 130 - 141
• Main Author: KATSU, Masataka
• Format: Journal Article
• Language: Japanese
• Published: Japan The Japanese Association for Infectious Diseases 01.04.1971
• Subjects: Adolescent; Adrenal Cortex Hormones - administration & dosage; Adult; Aged; Anti-Bacterial Agents - therapeutic use; Cephalosporins - therapeutic use; Endocarditis, Subacute Bacterial - drug therapy; Erythromycin - therapeutic use; Female; Humans; Kanamycin - therapeutic use; Lincomycin - therapeutic use; Male; Microbial Sensitivity Tests; Oleandomycin - therapeutic use; Penicillin G - therapeutic use; Penicillin Resistance; Staphylococcus - drug effects; Streptococcus - drug effects; Streptomycin - therapeutic use
• ISSN: 0387-5911; 1884-569X
• DOI: 10.11150/kansenshogakuzasshi1970.45.130

Although remarkable improvements have been made in the management, of subacute bacterial endocarditis (SBE) since the establishment of penicillin therapy, there remainmany problems confronting present-day physicians; above all others the choice of optimalantibiotics according to varying etiologies and conditions of individuals seems to, be the most sensitive one. The author has investigated, in this connection, the status mainly concerned withantibiotic therapy of SBE practiced in this country during 1955-1970 period, sending questionnaires to116 major medical institutes across the nation. Of all 445 cases contributed to the author, bacteriologically-proved 393cases were carefully studied. In view of the frequency of the causative organisms, the authortook up SBE due to streptococcus viridans (St. viridans) and staphylococcus as the subject of the title of this report. After the results were recorded, the author's judgement was presented as to the recommendable formulas at the selection and use of antibiotics in each case. The summary is as follows: 1. Responsible organisms and the number of cases: St. viridans-284 patients, Staph. aureus-55, Staph. epidermidis-12, and unclassified Staphylococcus-10. Cases due to St. viridans occupied72.3% of all SBE cases. 2. Advisable formulas in the case of St. viridans: a. Choice of antibiotics: crystalline PC-G b. Standard dosis and its duration: 4.8-6.8 million units/ day (devided i.m. injections every 3 hours) for 5-7 weeks. c. If the standard dosis proved ineffective, dosis should be doubled or KM (or SM) 2.0gm/ day be added. Macrolides or Cephalosporines or sometimes Benemid may also considered. 3. Advisable formulas in the case of staphylococcal endocarditis: a. In the case of PC-G sensitive strain: PC-G b. In the case of PC-G resistant strain: Cloxacillin (4.0-8.0 gm/ day, i. m. injection every3 hours for 5-7 weeks. The dosis may be increased up to 12 gm/ day if necessary) is the firstchoice and MDIPC, MFI-PC, Macrolides, Cephalosporines (per. os., i. m., i. v.) are the second. In theineffective cases, KM or SM may be added to the antibiotics listed above. In some cases 3 or 4drugs may be concomitantly necessary. 4. The determination of antibacterial potency of serum by double-fold serum inhibition method is valuable in judging the adequacy of the selection and dosis of antibiotics during the chemotherapyof SBE. If the growth of the causative organisms is inhibited by the 16fold or more diluted serum, thetreatment may considered to be effective. This method is quite useful in the practiceespecially when two or more antibiotics are concomitantly used. 5. In general, combined treatment of SBE by antibiotics and corticosteroids is not indicatedexcept for the followinginstances: a. critical cases with severe toxic manifestations, especially cases accompanied by circulatory collapse b. cases with penicillin allergy (Steroids may be usedwith PC-G) c. caseswith active rheumatic fever d. hypersensitive cases to the offending organismse.during the so-called immunological phases of SBE.