Treatment of Bacterial Endocarditis with Cephalothin

Ten patients with bacterial endocarditis were treated with cephalothin. Nine (Streptococcus viridans, four, microaerophilic streptococcus, two, anaerobic streptococcus, one, and Staphylococcus aureus, two) appeared cured when studied six months to four years after therapy ended. The tenth (Staph. albus) had negative blood cultures at the time of death. In seven, bacterial strains were available for testing, and growth was inhibited by a 30-μg cephalothin disk. In two other patients with enterococcal endocarditis, no serum bactericidal activity was demonstrated in vitro after administration of cephalothin in combination with streptomycin. Side effects of cephalothin included mild rashes, fever and superficial thrombophlebitis. An excessive blood level (51 μg per milliliter) developed in a patient who had a serum creatinine of 2.2 mg per 100 ml. In another, serum creatinine rose from 1.7 to 6.6 mg per 100 ml after 8 gm daily for 23 days. Cephalothin appears to be an excellent substitute for penicillin in treating bacterial endocarditis due to Staph. aureus or streptococcus other than enterococcus in patients for whom penicillin G is contraindicated.