A pediatric patient with Staphylococcus aureus endocarditis was treated unsuccessfully with methicillin 74 mg/kg/day as an initial dosage and 185 mg/kg/day as a maximum dosage over a 21-day period. Treatment failure was a result of apparent methicillin resistance, which may have been induced by the initial use of suboptimum methicillin dosages. The methicillin was discontinued and the patient became afebrile within six hours of receiving a combination of cephalothin and gentamicin. Combination therapy was continued for a total of 42 days, with eventual trough serum MBC dilutions of 1:32 and gentamicin and cephalothin dosages of 2.7 and 166 mg/kg/day respectively.
The patient was cured without any adverse sequelae. The rapid improvement in this patient's condition and his cure after receiving the combination therapy was probably due to the synergistic activity of gentamicin and cephalothin against S. aureus.
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