Backes R J, Wilson W R, Geraci J E
Arch Intern Med. 1985 Apr;145(4):693-6.
From 1970 to 1983, five patients with group B streptococcal endocarditis were treated at the Mayo Clinic, Rochester, Minn. The minimal inhibitory concentration and the minimal bactericidal concentration of penicillin were 0.09 microgram/mL or less and 1.56 micrograms/mL or less, respectively. The in vitro activity of cefazolin against group B streptococci was similar to that of penicillin. In three of the five cases, penicillin and streptomycin acted synergistically in vitro against group B streptococci. Four of the five patients were cured, three by use of an aminoglycoside combined with penicillin, ampicillin, or vancomycin. Three of the five patients had multiple large systemic emboli, and one of the three died of brain-stem infarct. Penicillin alone or in combination with an aminoglycoside is effective therapy for group B streptococcal endocarditis. Patients unable to tolerate penicillin may be treated with cefazolin or vancomycin. Clindamycin therapy should be avoided in patients with endocarditis caused by strains that are tolerant in vitro to clindamycin.
1970年至1983年期间，明尼苏达州罗切斯特市梅奥诊所收治了5例B组链球菌性心内膜炎患者。青霉素的最低抑菌浓度和最低杀菌浓度分别为0.09微克/毫升或更低以及1.56微克/毫升或更低。头孢唑林对B组链球菌的体外活性与青霉素相似。5例中有3例，青霉素和链霉素在体外对B组链球菌具有协同作用。5例患者中有4例治愈，3例通过使用氨基糖苷类药物联合青霉素、氨苄西林或万古霉素治愈。5例患者中有3例发生多处大的全身性栓塞，其中1例死于脑干梗死。单用青霉素或与氨基糖苷类药物联合使用是治疗B组链球菌性心内膜炎的有效方法。无法耐受青霉素的患者可用头孢唑林或万古霉素治疗。对于由体外对克林霉素耐药的菌株引起的心内膜炎患者，应避免使用克林霉素治疗。
