THE TREATMENT OF SUBACUTE BACTERIAL ENDOCARDITIS WITH PENICILLIN: SECOND REPORT

Abstract

The authors report the treatment of 35 cases of subacute bacterial endocarditis with penicillin. The present report deals with the follow-up on 17 of the 20 patients previously reported as well as treatment of 15 additional cases. Widely varying doses of penicillin were administered, largely by constant intramusc. drip, best results being obtained when blood levels, averaging four times the amount necessary to inhibit the growth of the infecting organism in vitro, were maintained for 2-3 weeks. On the whole, it was found desirable to administer relatively large daily doses of from 500,000 to 2,000,000 units, depending on the sensitivity of the infecting organism to penicillin. The role of heparin in the treatment of this disease is discussed and the conclusion reached that its use is inadvisable except in rare circumstances. Of the 35 patients treated, 30 are alive and apparently cured of the infection with an average follow-up period of 14 months. With persistent therapy, it should be possible to cure the disease in a great majority of cases in which the organism is susceptible to penicillin.