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JAC Advance Access published online on August 13, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg360
© 2003 by The British Society for Antimicrobial Chemotherapy
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© 2003 The British Society for Antimicrobial Chemotherapy

Brief report

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

Joan Gavaldà 1 *, Pedro López Onrubia 1 , María Teresa Martín Gómez 1 , Xavier Gomis 1 , José Luis Ramírez 1 , Oscar Len 1 , Dolors Rodríguez 1 , Manuel Crespo 1 , Isabel Ruíz 1 , and Albert Pahissa 1

1 Infectious Diseases Research Laboratory, Infectious Diseases Division, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Avda. Vall d'Hebron, 119-129, 08035 Barcelona, Spain

* Corresponding author. E-mail: gavalda{at}hg.vhebron.es.

Received 24 March 2003 ; revised 4 June 2003 ; accepted 6 June 2003

Abstract

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 endocarditis resulting from E. faecalis.

Methods: Animals with catheter-induced endocarditis were infected intravenously with 108 cfu of the EF91 strain of E. faecalis and were treated for 3 days with ampicillin 2 g every 4 h administered as ‘human-like' (H-L) pharmacokinetics, plus gentamicin 1 mg/kg every 8 h H-L, or ceftriaxone 2 g every 12 h H-L alone or combined with gentamicin 6 mg/kg every 24 h administered subcutaneously.

Results: The results of therapy for experimental endocarditis resulting from EF91 showed that the combination of ampicillin plus ceftriaxone was as effective as ampicillin plus gentamicin. The triple combination did not improve on the overall efficacies of the two-drug combinations.

Conclusions: Because of its lower nephrotoxicity, ampicillin plus ceftriaxone may be a useful alternative therapy for E. faecalis endocarditis in selected patients.

Keywords: bacteria, intravascular infections, animal models, antibiotic combinations
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