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JAC Advance Access published online on March 20, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl087
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Review

Antimicrobial treatment of infective endocarditis caused by viridans streptococci highly susceptible to penicillin: historic overview and future considerations

D. W. M. Verhagen 1, A. C. Vedder 2, P. Speelman 2, and J. T. M. van der Meer 2 *

1 Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Centre, Amsterdam, The Netherlands; Department of Internal Medicine, Free University Medical Centre, Amsterdam, The Netherlands
2 Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Centre, Amsterdam, The Netherlands

* To whom correspondence should be addressed.
J. T. M. van der Meer, E-mail: j.t.vandermeer{at}amc.uva.nl


  Abstract

In this article we present the path that led to current concepts regarding antimicrobial treatment of endocarditis caused by viridans streptococci highly susceptible to penicillin. Early treatment trials indicate that some patients with subacute endocarditis can be cured with shorter treatment duration than currently advised by international guidelines. Also, high-dose antibiotics, as recommended today, have a predominantly pharmacokinetic and pharmacodynamic rationale that is based mostly on experimental animal studies. Shortening antimicrobial treatment in select patients with endocarditis would be of great benefit. As yet there are no predictors of cure that can be used to individualize treatment duration in patients with bacterial endocarditis.

Keywords: antimicrobial therapy; Streptococcus spp.; subacute endocarditis.
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