DiNubile M J
Cooper Hospital University Medical Center, University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, Camden.
Ann Intern Med. 1994 Dec 1;121(11):873-6. doi: 10.7326/0003-4819-121-11-199412010-00009.
Right-sided endocarditis caused by Staphylococcus aureus is a frequent complication of injection drug use. Fortunately, the prognosis for this infection when treated with the standard regimen of 4 to 6 weeks of parenteral antistaphylococcal antibiotics is favorable. Nevertheless, in many cases, once drug users feel better, they leave the hospital against medical advice before completing the full course of antibiotic therapy. This problem has stimulated interest in shortening the duration of antibiotic to a penicillinase-resistant penicillin. Data from in vitro synergy studies and animal models of endocarditis suggest that S. aureus can be eradicated more quickly by combination therapy than by monotherapy. Reports of three prospective, nonrandomized clinical trials have been published that support the use of a 2-week course of a penicillinase-resistant penicillin and an aminoglycoside antibiotic to treat uncomplicated, exclusively right-sided endocarditis caused by methicillin-susceptible S. aureus in injection drug users.
由金黄色葡萄球菌引起的右侧心内膜炎是注射吸毒的常见并发症。幸运的是，采用4至6周肠外抗葡萄球菌抗生素标准疗程治疗这种感染，预后良好。然而，在许多情况下，吸毒者一旦感觉好转，就会不听从医嘱而离开医院，未能完成抗生素治疗的整个疗程。这个问题激发了人们对将抗生素疗程缩短至使用耐青霉素酶青霉素的兴趣。体外协同研究和心内膜炎动物模型的数据表明，联合治疗比单一治疗能更快根除金黄色葡萄球菌。已发表了三项前瞻性、非随机临床试验的报告，支持使用为期2周的耐青霉素酶青霉素和一种氨基糖苷类抗生素来治疗注射吸毒者中由甲氧西林敏感金黄色葡萄球菌引起的单纯性右侧心内膜炎。
