TREATMENT OF STREPTOCOCCAL ENDOCARDITIS WITH A SINGLE DAILY DOSE OF CEFTRIAXONE AND NETILMICIN FOR 14 DAYS - A PROSPECTIVE MULTICENTER STUDY

A 2-week course of ceftriaxone (2 g) plus netilmicin (4 mg/kg), admini stered as one short daily iv infusion, was evaluated for the treatment of streptococcal endocarditis in an open multicenter study. Of the 52 patients, 31 were infected with viridans streptococci, 18 with Strept ococcus bovis, two with Gemella morbillorum, and one with group C Stre ptococcus; 48 patients were assessable. Infection was cured in 42 case s, 35 treated medically and seven treated both medically and surgicall y. Five patients died without evidence of active infection, and one re lapsed. The bacteriologic failure was due to a strain of G. morbilloru m against which no synergy of ceftriaxone and netilmicin was evident i n vitro. The serum creatinine level increased during treatment in four cases, all involving patients >65 years old who had renal risk factor s; in two of these cases, values did not return to baseline during fol low-up. Of 40 patients assessed for auditory function, only one develo ped decreased perception of borderline significance. Other adverse rea ctions were mild. This regimen was efficacious, safe, and cost-effecti ve for the treatment of streptococcal endocarditis. However, it must b e used with caution for patients with preexisting renal impairment or concomitant exposure to other potentially nephrotoxic agents.