Conquering the pneumococcal nemesis with oral antibiotics. Issue 1 (2nd January 2020)

• Record Type: Journal Article
• Authors: Garris, Rana; Abanoub, Rushdy; Qaqa, Firas; Rana, Chirag; Guragai, Nirmal; Habib, Habib A.; Shamoon, Fayez; Bikkina, Mahesh
• Is Part Of: Journal of community hospital internal medicine perspectives. Volume 10:Issue 1(2020)
• Page Start: 65
• Page End: 68
• Publication Date: 2020-01-02
• Subjects: Infectious endocarditis -- pneumococcus -- treatment strategies; Internal medicine -- Periodicals; Hospitals -- Periodicals; Hospitals, Community; Internal Medicine; Hospitals; Internal medicine; Periodicals; Periodicals; 610
• DOI: 10.1080/20009666.2019.1708637
• Languages: English
• ISSNs: 2000-9666

Abstract

ABSTRACT: Introduction: Streptococcus pneumoniae endocarditis (SPE) occurs in <3% of all EI cases due to the evolution of penicillin and vaccination. However, immunocompromised and unvaccinated patients are still at grave risk. Case: A 58-year-old African American male who used alcohol and intravenous (IV) drugs presented with confusion, fever, and hemoptysis. He had coarse rhonchi with a grade 2/5 holosystolic apical murmur. CT chest showed diffuse bilateral infiltrates. Blood cultures were positive for pansensitive Streptococcus pneumoniae . Echocardiogram demonstrated large vegetations on the anterior and posterior leaflets of the mitral valve with flail leaflet and severe eccentric mitral regurgitation. Patient was started on IV ceftriaxone, but after 3 weeks of therapy, he wished to leave against medical advice. He was discharged on combination oral therapy with successful resolution of SPE on follow-up. Discussion: Invasive pneumococcus is highly virulent causing irreversible valvular destruction or death. IV beta-lactams are first-line treatment, but there are currently no guideline-recommended alternatives for oral therapy. Recent data suggest partial oral therapy may be noninferior to IV only therapy. Conclusion: Switching to oral combination antibiotics after at least 2 weeks of IV therapy is an acceptable alternative to treat SPE.