Failure of vancomycin treatment in Staphylococcus aureus endocarditis. In vivo and in vitro observations

JAMA. 1976 Oct 4;236(14):1604-6.


In a case of staphylococcal endocarditis, we failed to eradicate Staphylococcus aureus from the blood stream with vancomycin hydrochloride therapy. The strain involved was sensitive to vancomycin by disk diffusion studies but showed a wide disparity between minimal inhibitory and minimal bactericidal concentrations. The lack of a bactericidal effect was probably responsible for the failure of treatment. A synergistic effect was demonstrated for the combination of gentamicin sulfate and methicillin sodium, and the patient was ultimately cured with this combination plus vancomycin. Bactericidal tests are important in choosing an antimicrobial agent for treatment of endocarditis.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Blood / microbiology
  • Drug Evaluation
  • Drug Synergism
  • Endocarditis, Bacterial / drug therapy*
  • Endocarditis, Bacterial / etiology
  • Gentamicins / therapeutic use
  • Humans
  • Male
  • Methicillin / therapeutic use
  • Staphylococcal Infections / drug therapy*
  • Staphylococcus aureus / isolation & purification
  • Vancomycin / administration & dosage
  • Vancomycin / therapeutic use*


  • Gentamicins
  • Vancomycin
  • Methicillin