title: Ceftriaxone once daily for four weeks compared with ceftriaxone plus gentamicin once daily for two weeks for treatment of endocarditis due to penicillin-susceptible streptococci. Endocarditis Treatment Consortium Group.
abstract: This randomized, multicenter, open-label study compared the efficacy and safety of monotherapy with 2 g of intravenous ceftriaxone once daily for 4 weeks with those of combination therapy with 2 g of intravenous ceftriaxone and 3 mg of intravenous gentamicin/kg once daily for 2 weeks as therapy for endocarditis due to penicillin-susceptible streptococci. Sixty-one patients were enrolled in the study. Clinical cure was observed for 51 evaluable patients both at termination of therapy and at the 3-month follow-up: 25 (96.2%) of 26 monotherapy recipients and 24 (96%) of 25 combination therapy recipients. Of the 23 patients in each treatment group who were microbiologically evaluable, 22 (95.7%) in each group were considered cured. No patient had evidence of relapse. Fourteen patients (27.5%) required cardiac surgery after initiation of treatment, including five monotherapy recipients and nine combination therapy recipients. Adverse effects were minimal in both treatment groups. We conclude that 2 g of ceftriaxone once daily for 4 weeks and 2 g of ceftriaxone in combination with 3 mg of gentamicin/kg once daily for 2 weeks are both effective and safe for the treatment of streptococcal endocarditis.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Sexton
authors.forename: M J
authors.initials: MJ
authors.lastname: Tenenbaum
authors.forename: W R
authors.initials: WR
authors.lastname: Wilson
authors.forename: J M
authors.initials: JM
authors.lastname: Steckelberg
authors.forename: A D
authors.initials: AD
authors.lastname: Tice
authors.forename: D
authors.initials: D
authors.lastname: Gilbert
authors.forename: W
authors.initials: W
authors.lastname: Dismukes
authors.forename: R H
authors.initials: RH
authors.lastname: Drew
authors.forename: D T
authors.initials: DT
authors.lastname: Durack
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002443:Ceftriaxone / Q000008:administration & dosage / Q000627:therapeutic use*; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D010406:Penicillins / Q000494:pharmacology; D013290:Streptococcal Infections / Q000188:drug therapy*; D013291:Streptococcus / Q000187:drug effects
chemical_list: D002511:Cephalosporins; D005839:Gentamicins; D010406:Penicillins; D002443:Ceftriaxone