Malacoff R F, Frank E, Andriole V T
JAMA. 1979 Apr 27;241(17):1807-10.
A 14-year experience with streptococcal endocarditis was reviewed. The effect of single vs combination antibiotic therapy on the relapse rate was found to be comparable. Of 68 patients treated, four patients died during therapy. Two of 46 patients receiving single-agent and none of 18 patients receiving combination therapy experienced a relapse. Duration of symptoms before diagnosis was the main risk factor predisposing to relapse, which occurred in two of 13 patients with symptoms for longer than three months and in none of 51 patients with symptoms for three months or less before diagnosis. Combination therapy offered no advantage over a single agent in the latter group. Optimal therapy for patients with symptoms for longer than three months could not be determined in this study. However, no relapses were observed in this high-risk group when a single agent was given for longer than 21 days.
回顾了链球菌性心内膜炎14年的治疗经验。发现单药治疗与联合抗生素治疗对复发率的影响相当。在接受治疗的68例患者中，有4例在治疗期间死亡。接受单药治疗的46例患者中有2例复发，接受联合治疗的18例患者中无一例复发。诊断前症状持续时间是导致复发的主要危险因素，13例症状持续超过3个月的患者中有2例复发，而51例诊断前症状持续3个月或更短的患者中无一例复发。在后一组中，联合治疗并不比单药治疗更具优势。本研究无法确定症状持续超过3个月的患者的最佳治疗方案。然而，在这个高危组中，当给予单药治疗超过21天时，未观察到复发情况。
