Recovery from subacute bacterial endocarditis (Streptococcus fecalis): Report of two cases

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Abstract Two patients suffering from subacute bacterial endocarditis caused by S. fecalis have been presented. Because of the insensitivity of this organism to antibiotics now available, massive doses were used. One of these patients received 12 million units of penicillin a day for sixty days, or a total dosage of 720 million units of crystalline penicillin. The other patient received 20 million units a day, or a total dosage of 1.2 billion units. Both of these men are asymptomatic at this time and have shown no clinical or laboratory evidences of recurrence of their disease since their discharge from the hospital. The organisms of one of the patients were at first quite sensitive to streptomycin, being inhibited by 1 unit of the drug per cubic centimeter of medium. After the patient had received 4.0 Gm. of streptomycin intramuscularly for forty-eight hours, however, the organisms were resistant to 25 units of streptomycin per cubic centimeter of medium. It thus became impossible to reach effective therapy by the use of streptomycin for this patient. It is of importance to note that this same patient's organisms were insensitive to 20 units of amorphous penicillin per cubic centimeter but were sensitive to between 1.5 and 2.0 units of crystalline penicillin. Whether this was due to deterioration of the amorphous penicillin or whether a substandard drug was used is not known. In view of the above findings, however, we believe that crystalline penicillin should be used not only because of its more constant potency but also because of the fact that it is less painful to administer. It is interesting to note that the one patient developed his initial arteritis six months before he showed any clinical evidence of cardiac involvement. In spite of careful daily search, the valvular lesion did not become evident until the fifteenth day after penicillin therapy had been started.