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Comparison of two combinations of antibiotics in the treatment of infectious endocarditis caused by Enterococcus faecalis

The study by Spanish scientists aimed to compare the effectiveness of the combinations ampicillin + ceftriaxone (group 1) and ampicillin + gentamicin (group 2) in the treatment of infectious endocarditis caused by Enterococcus faecalis .

This comparative non-randomized multicentre observational cohort study involved 17 hospitals in Spain and 1 Italian hospital. The results of the study were published in the February issue of Clinical Infectious Diseases. The study systematically included adult patients with diagnosed infectious endocarditis caused by Enterococcus faecalis. The main parameters evaluated were death during treatment and within 3 months of the end of treatment, adverse events requiring discontinuation of treatment, ineffective treatment with replacement of antibiotics and relapses.

A significantly higher percentage of patients (n = 159) who received the ampicillin + ceftriaxone combination had anamnestic indications of chronic renal failure compared to patients who were prescribed the combination of ampicillin + gentamicin (n = 87) (33% vs 16%, p = 0.004). In addition, the group receiving ampicillin + ceftriaxone had a higher incidence of oncopathology (18% vs 7%, p = 0.015), of transplantation (6% vs 0 %, p = 0.040) as well as cases of infection associated with the provision of medical care (59% vs 40%, p = 0.006). It turned out that between patients with infectious endocarditis E. faecalis, who received two combinations of antibiotics compared, there was no difference in the frequency of death during treatment (22% vs 21%, p = 0.81), death at 3 months the period after the end of treatment (8% vs 7%, p = 0.72), the development of ineffective treatment which required the replacement of an antibiotic (1% vs 2%, p = 0.54) and in the frequency of relapses (3 % vs 4%, p = 0.67). At the same time, discontinuation of treatment due to the development of adverse events was noted much more often in the group receiving ampicillin + gentamicin, compared to the combination ampicillin + ceftriaxone (25% vs 1%, p less than 0.001), mainly due to renal failure (the increase in serum creatinine concentration is greater than 25% of the initial values) (23% vs 0%, p less than 0.001).

Thus, the combination ampicillin + ceftriaxone seems to be as effective as the standard ampicillin + gentamicin regimen in patients with infectious endocarditis caused by Enterococcus faecalis. This alternative treatment option can be used without risk (even virtual) of developing renal failure and despite the high prevalence of resistance to aminoglycosides in E. faecalis.