Ristocetin in Bacterial Endocarditis

Abstract

The discovery of penicillin and its use in the treatment of bacterial endocarditis was the first major advance in the management of this very serious disease. The demonstration that concurrent penicillin and streptomycin are usually more effective than penicillin alone accounted for the next therapeutic achievement. This combination, generally considered to be the most effective bactericidal therapy now available for penicillin-sensitive α-hemolytic streptococcal endocarditis, has shortened the duration of antimicrobial treatment for this entity. It has also proved to be significantly more effective for enterococcal endocarditis than penicillin alone. The third advance in the therapy of bacterial endocarditis was the successful short-term therapy of enterococcal endocarditis with ristocetin, first reported at the Antibiotic Symposium in 1957.¹ This report revealed the adequacy of 14 days of therapy with ristocetin, and indicated a greater effectiveness than that achieved using penicillin and streptomycin for 6 or more weeks. The purpose of this