Few cases of streptococcal endocarditis are resistant to penicillin

A combination of penicillin and gentamicin is the recommended treatment for streptococcal endocarditis. The Public Health Laboratory Service routinely tests 15% of endocarditis isolates, and on p 395 Johnson et al describe how they retrospectively analysed the antimicrobial susceptibility of streptococci isolates received over four years. They found that 88% of the isolates were susceptible to penicillin and none had high levels of resistance to gentamicin. There was no resistance to vancomycin. The authors conclude that the recommended treatment is appropriate for most patients, with vancomycin and gentamicin an alternative in those who have resistant isolates.

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