Brief communication: treatment of Enterococcus faecalis endocarditis with ampicillin plus ceftriaxone.
نویسندگان
چکیده
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. DESIGN Observational, open-label, nonrandomized, multicenter clinical trial. SETTING 13 centers in Spain. PATIENTS 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. INTERVENTION 6-week course of intravenous ampicillin, 2 g every 4 hours, plus intravenous ceftriaxone, 2 g every 12 hours. MEASUREMENTS 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 Treatment was withdrawn in 1 case because of fever and skin rash. LIMITATIONS The study had a small sample and was observational. CONCLUSION 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.
منابع مشابه
Efficacy of ampicillin combined with ceftriaxone and gentamicin in the treatment of experimental endocarditis due to Enterococcus faecalis with no high-level resistance to aminoglycosides.
OBJECTIVE This study tests the usefulness of ceftriaxone combined with ampicillin as an alternative to ampicillin plus gentamicin for the treatment of experimental endocarditis due to Enterococcus faecalis without high-level resistance to aminoglycosides. It also determines whether adding ceftriaxone to ampicillin and gentamicin increases the effectiveness against experimental enterococcal endo...
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The purpose of this work was to evaluate the in vitro possibilities of ampicillin-ceftriaxone combinations for 10 Enterococcus faecalis strains with high-level resistance to aminoglycosides (HLRAg) and to assess the efficacy of ampicillin plus ceftriaxone, both administered with humanlike pharmacokinetics, for the treatment of experimental endocarditis due to HLRAg E. faecalis. A reduction of 1...
متن کاملSummaries for patients. Successful treatment of aminoglycoside-resistant endocarditis with ampicillin and ceftriaxone.
Almirante, and A. Pahissa. What is the problem and what is known about it so far? Endocarditis (infection of the inside the heart) is a fatal disease that requires prompt antibiotic therapy. Many different kinds of bacteria can cause endocarditis, including a bacterium known as Enterococcus faecalis (or E. faecalis). The American Heart Association recommends that E. faecalis endocarditis be tre...
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ورودعنوان ژورنال:
- Annals of internal medicine
دوره 146 8 شماره
صفحات -
تاریخ انتشار 2007