JAC Advance Access originally published online on March 20, 2006
Journal of Antimicrobial Chemotherapy 2006 57(6):1255; doi:10.1093/jac/dkl100
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Correspondence |
Comment on: The role of aminoglycosides in combination with a ß-lactam for the treatment of bacterial endocarditis: a meta-analysis of comparative trials
Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine Rochester, MN 55905, USA
*Corresponding author. Tel: +1-507-255-7761; Fax: +1-507-255-7767; E-mail: baddour.larry{at}mayo.edu
Keywords: endocarditis , ß-lactams , aminoglycosides
Sir,
Falagas and colleagues performed a meta-analysis of comparative trials to determine the role, if any, of aminoglycosides in combination with a ß-lactam antibiotic for the treatment of infective endocarditis caused by Gram-positive cocci.1 They are to be congratulated on their thorough analysis and their many fine contributions to the literature.
One point in the Discussion section of the article1 deserves further clarification. The authors state that ‘the addition of gentamicin to penicillin G or ceftriaxone is highly recommended by the AHA for the first 2 weeks of treatment’ in the latest published statement2 and that findings from their meta-analysis did not support this position. As outlined in their review, only one trial3 that pertained to streptococci was included in the analysis and that investigation examined monotherapy versus dual therapy for native valve endocarditis caused by either viridans group streptococci or Streptococcus bovis. It is noteworthy that only patients who had streptococcal isolates that were susceptible to penicillin, ceftriaxone and gentamicin were included in the study; ‘resistance’ to penicillin of the initial blood culture isolate was an exclusion criterion. The authors did not, however, provide the specific in vitro susceptibility data (MIC) for the isolates.
Due to the success of ß-lactam monotherapy in this trial3 and other investigations, both the current2 and previous4 versions of the AHA ‘treatment guidelines’ listed only ß-lactam monotherapy as a 4 week treatment option for native valve endocarditis caused by penicillin-susceptible (MIC 
0.12 mg/L) viridans group streptococci and S. bovis. The current guidelines do recommend that the first 2 weeks of treatment of native valve endocarditis caused by streptococci that have higher (>0.12 to 0.5 mg/L) MICs of penicillin receive combination therapy with gentamicin.
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References
1
Falagas ME, Matthaiou DK, Bliziotis IA. (2006) The role of aminoglycosides in combination with a ß-lactam for the treatment of bacterial endocarditis: a meta-analysis of comparative trials. J Antimicrob Chemother 57:639–47.
2
Baddour LM, Wilson WR, Bayer AS, et al. (2005) Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association. Circulation 111:e394–434.
3 Sexton DJ, Tenenbaum MJ, Wilson WR, et al. (1998) Ceftriaxone once daily for four weeks compared with ceftriaxone plus gentamicin once daily for two weeks for treatment of endocarditis due to penicillin-susceptible streptococci. Clin Infect Dis 27:1470–4.[Web of Science][Medline]
4
Wilson WR, Karchmer AW, Dajani AS, et al. (1995) Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. JAMA 274:1706–13.
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  M. E. Falagas, D. K. Matthaiou, and I. A. Bliziotis Aminoglycosides in combination with a {beta}-lactam for the treatment of bacterial endocarditis: authors' response J. Antimicrob. Chemother., June 1, 2006; 57(6): 1255 - 1256. [Full Text] [PDF]
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