The Treatment of Bacterial Endocarditis with Penicillin

Penicillin Treatment of Subacute Bacterial Endocarditis

“…In this case the history of infection was comparatively short and the general condition of the patient good, but it is clear that the heart had been considerably damaged by the infection. Great care is necessary during the period of increasing activity following successful treatment, however well the patient may appear when resting in bed; similar opinions were expressed by Anderson and Keefer (1945) and Meads, Harris, and Finland (1945).…”

“…3-32 Favour, Janeway, Gibson, and Levine (1946) .. 17 11 6-18 Flippin, Mayock, Murphy, and Wolferth (1945) (1945) .. 54 37 2-15 Meads, Harris, and Finland (1945) .. 9 7 1-11 Mokotoff, Brams, Katz, and Howell (1946) Anderson and Keefer (1945); Geiger and Gomer (1946); Hines and Kessler (1945); Kelson (1945); Paullin and McLouglin (1945); Russek et al (1945); Vesell and Kross (1946) (1944) were successful in 3 of 10 cases. At this time Keefer (1944) stated that of 55 cases treated in the United States only 3 were alive a year later.…”

“…Before removal of the heart all the great vessels -were tied; the heart was then removed intact. With aseptic precautions the ventricular wall Meads et al (1945); it probably represents an early stage in the response to penicillin and may explain the need to continue treatment long after the blood is sterile. In Cases 9, 12, and 23, we cannot regard the infection as controlled, but there was some response to treatment in Case 12; this supports the suggestion recently made by Gordon and Zinnemann (1945) that some strains of Ha?mophilus influenze are sensitive in vitro to high concentrations of penicillin.…”

Penicillin Treatment of Subacute Bacterial Endocarditis

“…3-32 Favour, Janeway, Gibson, and Levine (1946) .. 17 11 6-18 Flippin, Mayock, Murphy, and Wolferth (1945) (1945) .. 54 37 2-15 Meads, Harris, and Finland (1945) .. 9 7 1-11 Mokotoff, Brams, Katz, and Howell (1946 Anderson and Keefer (1945); Geiger and Gomer (1946); Hines and Kessler (1945); Kelson (1945); Paullin and McLouglin (1945); Russek et al (1945); Vesell and Kross (1946 7 of these, in which treatment was completed less than six months ago, are excluded. This period has been selected because in published cases, death has so far not occurred more than six months after successful treatment except from heart failure or unrelated causes.…”

“…Penicillin pyrexia is of no prognostic significance, for of these 13 cases only 3 died. Recurrence of pyrexia during treatment has been previously recorded by Dawson and Hobby (1944), Anderson and , Bloomfield and Halpern (1945), Meads et al (1945), and Bloomfield et al (1945); it has usually been attributed to emboli, infection by injections or drips, or to absorption of healing lesions, but Dawson and Hobby (1944) and Bloomfield and Halpern (1945) considered it might be due to penicillin or an associated impurity. It is agreed that pyrexia during treatment does not necessarily indicate failure to control the infection.…”