Treatment of Staphylococcus aureus Endocarditis

TO THE EDITOR.— The report of Murray et al in the Archieves (136:480-483, 1976) contains implications that if applied clinically might prove to be dangerous. The patient, who had Staphylococcus aureus endocarditis, continued with a low-grade fever up to 38.8 C during the first two weeks while being treated with methicillin sodium alone. He also had peripheral emboli with hematuria, left upper quadrant (abdominal?) pain, and an abnormal spleen scan. The emboli were probably the cause of the fever. Emboli can occur even after the institution of adequate antibiotic treatment for endocarditis.1 The authors failed to show that the initial regimen of methicillin was failing to achieve a bacteriologic remission. There is no data to support the contentions that rapid sterilization of vegetations prevents "further vital tissue destruction" or changes the fever. Defervescence should not be ascribed to the increased dosage of methicillin or to intermittent injections of gentamicin