title: Brief communication: treatment of Enterococcus faecalis endocarditis with ampicillin plus ceftriaxone.
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.
  
  
  METHODS
  Observational, open-label, nonrandomized, multicenter clinical trial.
  
  
  METHODS
  13 centers in Spain.
  
  
  METHODS
  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.
  
  
  METHODS
  6-week course of intravenous ampicillin, 2 g every 4 hours, plus intravenous ceftriaxone, 2 g every 12 hours.
  
  
  METHODS
  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 Treatment was withdrawn in 1 case because of fever and skin rash.
  
  
  CONCLUSIONS
  The study had a small sample and was observational.
  
  
  CONCLUSIONS
  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.
authors: Hospital Universitari Vall d'Hebron, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain. jgavalda@ir.vhebron.net
authors: Joan
authors: J
authors: Gavaldà
authors: Oscar
authors: O
authors: Len
authors: José M
authors: JM
authors: Miró
authors: Patricia
authors: P
authors: Muñoz
authors: Miguel
authors: M
authors: Montejo
authors: Aristides
authors: A
authors: Alarcón
authors: Julián
authors: J
authors: de la Torre-Cisneros
authors: Carmen
authors: C
authors: Peña
authors: Xavier
authors: X
authors: Martínez-Lacasa
authors: Cristina
authors: C
authors: Sarria
authors: Germán
authors: G
authors: Bou
authors: José M
authors: JM
authors: Aguado
authors: Enrique
authors: E
authors: Navas
authors: Joan
authors: J
authors: Romeu
authors: Francesc
authors: F
authors: Marco
authors: Carmen
authors: C
authors: Torres
authors: Pilar
authors: P
authors: Tornos
authors: Ana
authors: A
authors: Planes
authors: Vicenç
authors: V
authors: Falcó
authors: Benito
authors: B
authors: Almirante
authors: Albert
authors: A
authors: Pahissa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000494:pharmacology; D000667:Ampicillin / Q000009:adverse effects / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000188:drug therapy*; D013293:Enterococcus faecalis / Q000187:drug effects; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D000667:Ampicillin