Acute bacterial endocarditis due to Hemophilus parainfluenzae. Response to ceftizoxime in an ampicillin-allergic patient

Endocarditis secondary to Hemophilus parainfluenzae is an uncommon entity that appears to be increasing in frequency, perhaps due to improved laboratory isolation techniques. Although controversial, most of the published literature recommends a penicillin, with or without concomitant gentamicin, as definitive therapy. We report the first successful use of the third-generation cephalosporin ceftizoxime in an ampicillin-allergic patient. A 55-year-old white female was hospitalized after 5 days of experiencing fever, chills, nausea, and vomiting. A cardiac echocardiogram revealed a large mitral valve vegetation, and the patient was treated with intravenous ampicillin, gentamicin, and clindamycin. Two weeks after emergency mitral valve replacement the patient developed spiking fevers and a macular, erythematous rash while receiving ampicillin. Ceftizoxime was initiated and continued to complete a 4-week period of intravenous antibiotics. Follow-up at 14 months showed no further evidence of infection. Ceftizoxime appears efficacious in eradicating H. parainfluenzae in patients allergic to penicillin.