Journal
AMERICAN JOURNAL OF THE MEDICAL SCIENCES
Volume 324, Issue 1, Pages 51-53Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/00000441-200207000-00008
Keywords
endocarditis prophylaxis failure; Streptococcus mitis; penicillin resistance
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Antibiotic resistance among viridans streptococci has increased with Streptococcus mitis being more resistant than other viridans species. In a case presented in this report, it is possible that antibiotic resistance contributed to an apparent failure of endocarditis prophylaxis. The patient had undergone periodontal surgery on 2 separate occasions and in both instances was administered 2 g of amoxicillin orally 1 hour before each procedure. He subsequently developed a subacute illness and had multiple blood cultures drawn that grew S mitis with a minimum inhibitory concentration of 1.0 mug/mL for penicillin. Transesophageal echocardiogram provided further evidence of infective endocarditis with vegetations seen on the anterior leaflet of the mitral valve, Combination therapy with high-dose intravenous aqueous crystalline penicillin G and gentamicin sulfate for 4 weeks was curative. Clindamycin, rather than amoxicillin, has since been used as dental prophylaxis for subsequent procedures.
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