PEDIATRICS Vol. 35 No. 4 April 1965, pp. 704-708
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THERAPEUTIC PRINCIPLES FOR STREPTOCOCCUS VIRIDANS INFECTIONS: RECURRENT BACTERIAL ENDOCARDITIS IN A CHILD WITH CONGENITAL HEART DISEASE

Welton M. Gersony M.D.1 and Alexander S. Nadas M.D.1

1 Sharon Cardiovascular Unit of the Children's Hospital Medical Center and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts

A case of recurrent bacterial endocarditis due to a relatively resistant alpha streptococcus is reviewed. The following general principles of treatment are recommended:

1. Intravenous penicillin therapy should be instituted in all instances.

2. Should serum bactericidal levels indicate the organism to be extremely sensitive (< 0.1 units/ml) oral phenoxymethyl penicillin (Penicillin-V) may be substituted after 3 weeks.

3. In cases infected with organisms sensitive to greater than 0.1 units/ml, intravenous therapy should be continued for 6 weeks and streptomycin added for 2 weeks.

4. When facilities for studying penicillin sensitivity and serum bactericidal activity are not available, the intravenous penicillin-streptomycin regime is recommended.