Endocarditis enterococcal

Therapy for Native-Valve or Prosthetic-Valve Enterococcal Endocarditis Caused by Strains Susceptible to Penicillin, Gentamicin, and Vancomycin... 

Enterococcal endocarditis ordinarily requires 4 to 6 weeks of high-dose penicillin G or ampicillin, plus gentamicin for cure (Table 37-8). A 6-week course is recommended for patients with symptoms lasting longer than 3 months and those with PVE. 

For a enterococcal endocarditis 4-6 weeks of ampicillin or amoxicillin (6 x 2 g i.v. daily) plus... 

It is used in all forms of tuberculosis along with other antitubercular drugs. Other indications are tularemia, plague, brucellosis, bacterial endocarditis, entero-coccal endocarditis. Used concomitantly with penicillin G for synergistic effect in the treatment of enterococcal endocarditis when other antibiotics are ineffective or contraindicated. 

Penicillin plus streptomycin is effective for enterococcal endocarditis and 2-week therapy of viridans streptococcal endocarditis. Gentamicin has largely replaced streptomycin for these indications. Streptomycin remains a useful agent for treating enterococcal infections, however, because approximately 15% of enterococcal isolates that are resistant to gentamicin (and therefore to netilmicin, tobramycin, and amikacin) will be susceptible to streptomycin. 

Streptomycin Intramuscular, widespread resistance limits use to specific indications such as tuberculosis and enterococcal endocarditis... 

Question A.15 The appropriate regimen for this patient s enterococcal endocarditis is ... 

To obtain potentiation (or synergy ), i.e. an effect unobtainable with either drug alone, e.g. penicillin plus gentamicin for enterococcal endocarditis. 

Bacterial endocarditis. An aminoglycoside, usually gentamicin, should comprise part of the antimicrobial combination for enterococcal, streptococcal or staphylococcal infection of the heart valves, and for the therapy of clinical endocarditis which fails to yield a positive blood culture. 

Antimicrobial combination therapy is used frequently to treat serious infections. Combination therapy may be used prior to knowing the pathogen or antibiotic susceptibility for the treatment of infections in neutropenic patients and in patients with enterococcal endocarditis or bacteremia, sepsis, or pneumonia caused by P. aeruginosa. In these cases, it is important to know whether the combination will have beneficial (or detrimental) effects on the overall antibacterial activity of the regimen. For example, the combination may result in activity that is... 

The most obvious example of the use of synergy is the treatment of enterococcal endocarditis. The causative organism is usually only inhibited by penicillins, but it is killed rapidly by the addition of streptomycin or gentamicin to a penicillin. The need for bactericidal activity in the treatment of endocarditis underscores the need for these synergistic combinations. 

S-Lactam antibiotics, such as penicillin G, nafcillin, and ampicillin, remain the drugs of choice for streptococcal, staphylococcal, and enterococcal endocarditis, respectively. 

---