Role of tolerance in cloxacillin treatment of experimental Staphylococcus aureus endocarditis.

The role of Staphylococcus aureus tolerance was investigated in endocarditis in rats. The efficacies of cloxacillin, gentamicin, and a combination of the two were compared for animals infected with a tolerant strain, its kill-sensitive variant, or a nonisogenic nontolerant strain of S. aureus. Cloxacillin was significantly less effective for treating the tolerant than for the nontolerant strains. The addition of gentamicin to cloxacillin reduced bacterial numbers in endocardial vegetations for the tolerant strain comparable to the reduction by cloxacillin alone for the nontolerant strains, but had no additional effect for the nontolerant strains. Isolates from animals infected with the tolerant or nontolerant strains during antibiotic treatment remained tolerant or nontolerant. These results show that the in vitro phenomenon of tolerance is relevant in vivo.