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Urs P. Steinbrecher, MD

Arch Intern Med. 1981;141(12):1714-1715.

Abstract
• This report describes a patient with group B streptococcal (GBS) bacteremia with pyelonephritis and septic arthritis whose condition failed to improve after two weeks of therapy with penicillin G sodium. The organism was found to be tolerant to penicillin (minimal inhibitory concentration, 0.06 IU/mL; minimal bactericidal concentration [MBC], 10 lU/mL). Antimicrobial synergy with gentamicin sulfate was demonstrated (MBC of penicillin was 0.07 IU/mL in the presence of 2.5 µg/mL of gentamicin). Addition of gentamicin to penicillin therapy was associated with clinical improvement, It is suggested that bactericidal rather than inhibitory susceptibility tests be employed as a guide to therapy in serious GBS infections. Where penicillin tolerance is found in association with a poor clinical response to penicillin, addition of an aminoglycoside should be considered. Antimicrobial synergy studies should be performed to demonstrate that a beneficial effect is possible at clinically attainable antibiotic concentrations.

(Arch Intern Med 1981;141:1714-1715)

Author Affiliations
From the Department of Medicine, McGill University Clinic, Royal Victoria Hospital, Montreal.

Footnotes
Accepted for publication Jan 7, 1981.

Reprint requests to Department of Medicine, Room A4.02, Royal Victoria Hospital, McGill University Clinic, 687 Pine Ave W, Montreal H3A 1A1 Quebec, Canada (Dr Steinbrecher).

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