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Ann Intern Med. 2007 Apr 17;146(8):574-9.

Brief communication: treatment of Enterococcus faecalis endocarditis with ampicillin plus ceftriaxone.

Author information

  • 1Hospital Universitari Vall d'Hebron, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain. jgavalda@ir.vhebron.net

Abstract

BACKGROUND:

High-level aminoglycoside resistance (HLAR) that precludes bactericidal synergism with penicillins or glycopeptides and nephrotoxicity related to aminoglycoside treatment are major problems in treating Enterococcus faecalis endocarditis.

OBJECTIVE:

To evaluate the efficacy and safety of ampicillin plus ceftriaxone for treating endocarditis due to E. faecalis with and without HLAR.

DESIGN:

Observational, open-label, nonrandomized, multicenter clinical trial.

SETTING:

13 centers in Spain.

PATIENTS:

21 patients with HLAR E. faecalis endocarditis and 22 patients with non-HLAR E. faecalis endocarditis. All were at risk for nephrotoxicity related to aminoglycoside use.

INTERVENTION:

6-week course of intravenous ampicillin, 2 g every 4 hours, plus intravenous ceftriaxone, 2 g every 12 hours.

MEASUREMENTS:

Clinical and microbiological outcomes.

RESULTS:

The clinical cure rate at 3 months was 67.4% (29 of 43 patients) among all episodes. During treatment, 28.6% of patients with HLAR E. faecalis endocarditis and 18.2% of patients with non-HLAR E. faecalis endocarditis died of infection-related causes. The rate of clinical and microbiological cure in patients who completed the protocol was 100% in the HLAR E. faecalis endocarditis group. No episodes of breakthrough bacteremia occurred, although there were 2 relapses in the non-HLAR E. faecalis endocarditis group. Treatment was withdrawn in 1 case because of fever and skin rash.

LIMITATIONS:

The study had a small sample and was observational.

CONCLUSION:

The combination of ampicillin and ceftriaxone is effective and safe for treating HLAR E. faecalis endocarditis and could be a reasonable alternative for patients with non-HLAR E. faecalis endocarditis who are at increased risk for nephrotoxicity.

PMID:
17438316
[PubMed - indexed for MEDLINE]
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