Espinosa F J, Valdés M, Martín-Luengo F, Arribas J P, Albaladejo J, Pérez-Gracia A, García-Henarejos J A, Martínez-Madrid O, García-Alberola A
Servicio de Medicina Interna, Hospital Santa María del Rosell, Cartagena, Murcia.
Enferm Infecc Microbiol Clin. 1993 May;11(5):235-40.
Intravenous drug addicts (IVDA) are a group of patients in whom it is difficult to complete standard treatment of infectious endocarditis due to frequent antisocial behavior and in whom, once clinical improvement is achieved, voluntary discharge is frequently requested. This is why the evaluation of new treatment schedules tending to decrease the length of the same is of great interest. This non randomized study has the aim of knowing the efficacy of a short treatment with cloxacillin or vancomycin associated to gentamicin in right-sided endocarditis by methicillin-sensitive Staphylococcus aureus, comparing this with the standard schedule of 28 days.
This series was made up of IVDA patients diagnosed of right endocarditis by S. aureus. Inclusion criteria were the presence of intravenous drug addiction, isolation of methicillin-sensitive S. aureus in 2 or more blood cultures and achievement of the diagnostic criteria of right-sided endocarditis. Two schedules were used: a) standard: cloxacillin or vancomycin for 4 weeks, associating aminoglucoside in the first 3-5 days; b) short; cloxacillin or vancomycin associated to gentamicin for 2 weeks with no ulterior treatment. The study was not randomized and the treatment of 2 weeks was compared with historic controls treated for 4 weeks. The criteria evaluated were those of clinical cure, relapse, appearance of complications during treatment and mortality.
Both the standard treatment and the combination of cloxacillin or vancomycin with gentamicin for 2 weeks cured 100% of the episodes of right endocarditis by S. aureus. There were no relapses and mortality was nul. Neither were there any differences between the two groups with regard to appearance of complications.
In intravenous drug addict patients with right-sided endocarditis by methicillin S. aureus, the association of cloxacillin and gentamicin for 2 weeks is an effective alternative to long (4 week) treatments with only one antibiotic. The low number of cases treated with vancomycin does not allow conclusions to be drawn on its efficacy.
静脉注射吸毒者（IVDA）是一类患者，由于其频繁的反社会行为，很难完成感染性心内膜炎的标准治疗，而且一旦临床症状有所改善，他们又常常要求自动出院。这就是为什么评估旨在缩短治疗时间的新治疗方案备受关注的原因。这项非随机研究旨在了解用氯唑西林或万古霉素联合庆大霉素进行短期治疗对耐甲氧西林金黄色葡萄球菌所致右侧心内膜炎的疗效，并将其与28天的标准治疗方案进行比较。
该系列研究由被诊断为金黄色葡萄球菌所致右侧心内膜炎的IVDA患者组成。纳入标准包括存在静脉吸毒成瘾、在两份或更多份血培养中分离出耐甲氧西林金黄色葡萄球菌以及达到右侧心内膜炎的诊断标准。采用了两种治疗方案：a）标准方案：氯唑西林或万古霉素治疗4周，在最初3 - 5天联合使用氨基糖苷类药物；b）短期方案：氯唑西林或万古霉素联合庆大霉素治疗2周，之后不再进行进一步治疗。该研究并非随机研究，将2周的治疗方案与接受4周治疗的历史对照进行比较。评估的标准包括临床治愈、复发、治疗期间并发症的出现以及死亡率。
标准治疗方案以及氯唑西林或万古霉素与庆大霉素联合使用2周的方案均使金黄色葡萄球菌所致右侧心内膜炎的发作治愈率达到100%。没有复发情况，死亡率为零。两组在并发症出现方面也没有差异。
对于耐甲氧西林金黄色葡萄球菌所致右侧心内膜炎的静脉注射吸毒者患者，氯唑西林和庆大霉素联合使用2周是仅用一种抗生素进行长期（4周）治疗的有效替代方案。由于使用万古霉素治疗的病例数量较少，无法就其疗效得出结论。
