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Int J Antimicrob Agents. 2019 Jun 8. pii: S0924-8579(19)30147-5. doi: 10.1016/j.ijantimicag.2019.06.006. [Epub ahead of print]

High-dose trimethoprim-sulfamethoxazole and clindamycin for Staphylococcus aureus endocarditis.

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Aix Marseille Univ., IRD, AP-HM, MEPHI, IHU Méditerranée Infection, Marseille, France.
USIC - SOS endocardites Fédération de cardiologie, CHU Henri Mondor, Créteil, France.
Urgences Néphrologiques et Transplantation Rénale, CHU Tenon, Paris, France.
Service d'Information Médicale, Hôpital de la Timone, Marseille, France.
Service de Cardiologie, Hôpital de la Timone, Marseille, France.
Service de Chirurgie Cardiaque, Hôpital de la Timone, Marseille, France.
Aix Marseille Univ., IRD, AP-HM, MEPHI, IHU Méditerranée Infection, Marseille, France. Electronic address:



The mortality rate for Staphylococcus aureus endocarditis remains as high as 20-30% despite improvements in medical and surgical treatment. This study evaluated the efficiency and tolerance of a combination of intravenous trimethoprim-sulfamethoxazole and clindamycin (T&C) +/- rifampicin and gentamicin, with a rapid switch to oral administration of T&C.


This before-after intervention study compared the outcomes of 170 control patients before introduction of the T&C protocol (2001-2011) with the outcomes of 171 patients in the T&C group (2012-2016). All patients diagnosed with S. aureus infective endocarditis and referred to the study centre between 2001 and 2016 were included. Between 2001 and 2011, the patients received a standardized antibiotic treatment: oxacillin or vancomycin for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol has included a high dose of T&C (intravenous, switched to oral administration on day 7). Rifampicin and gentamicin are also given in cases of cardiac abscess or persistent bacteraemia.


The two groups were slightly different. On intention-to-treat analysis, global mortality (19% vs 30%, P=0.024), in-hospital mortality (10% vs 18%, P=0.03) and 30-day mortality (7% vs 14%, P=0.05) were lower in the T&C group. The mean duration of hospital stay was significantly shorter in the T&C group (30 vs 39 days; P=0.005).


The management of S. aureus infective endocarditis using a rapid shift to oral administration of T&C reduced the length of hospital stay and the mortality rate.


Clindamycin; Endocarditis; Mortality; Oral route; Staphylococcus aureus; Trimethoprim-sulfamethoxazole

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