Brief communication: treatment of Enterococcus faecalis endocarditis with ampicillin plus ceftriaxone.
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 Treatment was withdrawn in 1 case because of fever and skin rash.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.
Gavaldà
Joan
J
Hospital Universitari Vall d'Hebron, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain. jgavalda@ir.vhebron.net
Len
Oscar
O
Miró
José M
JM
Muñoz
Patricia
P
Montejo
Miguel
M
Alarcón
Aristides
A
de la Torre-Cisneros
Julián
J
Peña
Carmen
C
Martínez-Lacasa
Xavier
X
Sarria
Cristina
C
Bou
Germán
G
Aguado
José M
JM
Navas
Enrique
E
Romeu
Joan
J
Marco
Francesc
F
Torres
Carmen
C
Tornos
Pilar
P
Planes
Ana
A
Falcó
Vicenç
V
Almirante
Benito
B
Pahissa
Albert
A
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
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D000667:Ampicillin