title: Ampicillin plus ceftriaxone is as effective as ampicillin plus gentamicin for treating enterococcus faecalis infective endocarditis.
abstract: BACKGROUND
  The aim of this study was to compare the effectiveness of the ampicillin plus ceftriaxone (AC) and ampicillin plus gentamicin (AG) combinations for treating Enterococcus faecalis infective endocarditis (EFIE).
  
  
  METHODS
  An observational, nonrandomized, comparative multicenter cohort study was conducted at 17 Spanish and 1 Italian hospitals. Consecutive adult patients diagnosed of EFIE were included. Outcome measurements were death during treatment and at 3 months of follow-up, adverse events requiring treatment withdrawal, treatment failure requiring a change of antimicrobials, and relapse.
  
  
  RESULTS
  A larger percentage of AC-treated patients (n = 159) had previous chronic renal failure than AG-treated patients (n = 87) (33% vs 16%, P = .004), and AC patients had a higher incidence of cancer (18% vs 7%, P = .015), transplantation (6% vs 0%, P = .040), and healthcare-acquired infection (59% vs 40%, P = .006). Between AC and AG-treated EFIE patients, there were no differences in mortality while on antimicrobial treatment (22% vs 21%, P = .81) or at 3-month follow-up (8% vs 7%, P = .72), in treatment failure requiring a change in antimicrobials (1% vs 2%, P = .54), or in relapses (3% vs 4%, P = .67). However, interruption of antibiotic treatment due to adverse events was much more frequent in AG-treated patients than in those receiving AC (25% vs 1%, P < .001), mainly due to new renal failure (≥25% increase in baseline creatinine concentration; 23% vs 0%, P < .001).
  
  
  CONCLUSIONS
  AC appears as effective as AG for treating EFIE patients and can be used with virtually no risk of renal failure and regardless of the high-level aminoglycoside resistance status of E. faecalis.
authors: Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain. nufernan@gmail.com
authors: Nuria
authors: N
authors: Fernández-Hidalgo
authors: Benito
authors: B
authors: Almirante
authors: Joan
authors: J
authors: Gavaldà
authors: Mercè
authors: M
authors: Gurgui
authors: Carmen
authors: C
authors: Peña
authors: Arístides
authors: A
authors: de Alarcón
authors: Josefa
authors: J
authors: Ruiz
authors: Isidre
authors: I
authors: Vilacosta
authors: Miguel
authors: M
authors: Montejo
authors: Nuria
authors: N
authors: Vallejo
authors: Francisco
authors: F
authors: López-Medrano
authors: Antonio
authors: A
authors: Plata
authors: Javier
authors: J
authors: López
authors: Carmen
authors: C
authors: Hidalgo-Tenorio
authors: Juan
authors: J
authors: Gálvez
authors: Carmen
authors: C
authors: Sáez
authors: José Manuel
authors: JM
authors: Lomas
authors: Marco
authors: M
authors: Falcone
authors: Javier
authors: J
authors: de la Torre
authors: Xavier
authors: X
authors: Martínez-Lacasa
authors: Albert
authors: A
authors: Pahissa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000667:Ampicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002443:Ceftriaxone / Q000008:administration & dosage*; D015331:Cohort Studies; D004359:Drug Therapy, Combination / Q000379:methods; D004696:Endocarditis / Q000188:drug therapy* / Q000382:microbiology; D013293:Enterococcus faecalis / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006761:Hospitals; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D013030:Spain; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002443:Ceftriaxone; D000667:Ampicillin