TREATMENT OF SUBACUTE BACTERIAL ENDOCARDITIS WITH PENICILLIN: REPORT OF CASES TREATED WITHOUT ANTICOAGULANT AGENTS

Abstract

Twelve patients with subacute bacterial endocarditis were treated with penicillin given in massive doses and prolonged courses. The outcome was successful in all but one case, and more than a yr. has elapsed since termination of therapy in 6 of the patients. The etio-logical type of the underlying heart disease was rheumatic or probably rheumatic in all, and the ages of the patients ranged from 11 to 63 yrs. The infecting organism in each instance was Streptococcus viridans, whose penicillin resistance ranged from 0.02 to 0.05 U. per ml. Penicillin was administered largely by continuous intraven. infusion in doses of from 200,000 to 600,000 units per day, which yielded serum penicillin concs. 2-4 times the in vitro inhibiting level of the infecting bacterium. The duration of treatment varied from 3 to 9 weeks in the successfully treated cases. Evidence is presented to show that of the 3 parenteral routes of penicillin administration employed[long dash]continuous intraven. infusion, continuous intramusc. infusion, and intermittent intramusc. injns. at 2-hr. intervals[long dash]the first was the most satisfactory.