Burch K H, Quinn E L, Cox F, Madhavan T, Fisher E, Romig D
Am J Cardiol. 1976 Dec;38(7):929-33. doi: 10.1016/0002-9149(76)90806-7.
Twenty-three patients with infective endocarditis received intramuscular clindamycin (Cleocin) for treatment. Thirteen had acute Staphylococcus (S.) aureus endocarditis but none had involvement of the aortic valve. Eleven of these 13 infections were heroin-related and involved the tricuspid valve.Twenty-one patients were successfully treated. Two patients with heroin-related S. aureus infection failed to respond to intramuscularly administered clindamycin, but responded to retreatment with methicillin. There have been 34 reported cases of endocarditis treated with clindamycin. Although 80 percent of all cases due to staphylococci responded favorably, almost all were heroin-related tricuspid valve infections. In addition 91 percent of cases due to aerobic streptococci responded but, surpisingly, treatment failed in three of four cases of anaerobic endocarditis. Although clindamycin can be useful in streptococcal endocarditis and in some cases of heroin-related S. aureus tricuspid endocarditis, caution should be exercised in its use. It is "less" bactericidal than the penicillins or cephalosporins, and organisms have become resistant during treatment. Furthermore, patients with anaerobic endocarditis have not responded well, and data are not available to recommend administration of clindamycin for acute S. aureus infections engrafted on the aortic or mitral valve.
23例感染性心内膜炎患者接受了克林霉素（氯洁霉素）肌肉注射治疗。其中13例患有急性金黄色葡萄球菌性心内膜炎，但均未累及主动脉瓣。这13例感染中有11例与海洛因相关，累及三尖瓣。21例患者治疗成功。2例与海洛因相关的金黄色葡萄球菌感染患者对肌肉注射克林霉素无反应，但再次使用甲氧西林治疗有效。已有34例心内膜炎患者使用克林霉素治疗的报道。虽然所有葡萄球菌引起的病例中有80%反应良好，但几乎所有病例都与海洛因相关的三尖瓣感染有关。此外，91%的需氧链球菌引起的病例有反应，但令人惊讶的是，4例厌氧性心内膜炎病例中有3例治疗失败。虽然克林霉素可用于治疗链球菌性心内膜炎以及某些与海洛因相关的金黄色葡萄球菌性三尖瓣心内膜炎，但使用时应谨慎。它的杀菌作用比青霉素或头孢菌素“弱”，而且在治疗过程中细菌会产生耐药性。此外，厌氧性心内膜炎患者对其反应不佳，且尚无数据推荐将克林霉素用于主动脉瓣或二尖瓣植入的急性金黄色葡萄球菌感染。
