Ampicillin Plus Ceftriaxone Combined Therapy for Enterococcus faecalis Infective Endocarditis in OPAT

Laura Herrera-Hidalgo, Jose Manuel Lomas-Cabezas, Luis Eduardo López-Cortés, Rafael Luque-Márquez, Luis Fernando López-Cortés, Francisco J Martínez-Marcos, Javier de la Torre-Lima, Antonio Plata-Ciézar, Carmen Hidalgo-Tenorio, Maria Victoria García-López, David Vinuesa, Alicia Gutiérrez-Valencia, Maria Victoria Gil-Navarro, Arístides De Alarcón, Laura Herrera-Hidalgo, Jose Manuel Lomas-Cabezas, Luis Eduardo López-Cortés, Rafael Luque-Márquez, Luis Fernando López-Cortés, Francisco J Martínez-Marcos, Javier de la Torre-Lima, Antonio Plata-Ciézar, Carmen Hidalgo-Tenorio, Maria Victoria García-López, David Vinuesa, Alicia Gutiérrez-Valencia, Maria Victoria Gil-Navarro, Arístides De Alarcón

Abstract

Ampicillin plus ceftriaxone (AC) is a well-recognized inpatient regimen for Enterococcus faecalis infective endocarditis (IE). In this regimen, ceftriaxone is usually administered 2 g every 2 h (AC12). The administration of AC in outpatient parenteral antibiotic treatment (OPAT) programs is challenging because multiple daily doses are required. AC regimens useful for OPAT programs include once-daily high-dose administration of ceftriaxone (AC24) or AC co-diluted and jointly administered in bolus every 4 h (ACjoined). In this retrospective analysis of prospectively collected cases, we aimed to assess the clinical effectivity and safety of three AC regimens for the treatment of E. faecalis IE. Fifty-nine patients were treated with AC combinations (AC12 n = 32, AC24 n = 17, and ACjoined n = 10). Six relapses occurred in the whole cohort: five (29.4%) treated with AC24 regimen and one (10.0%) with ACjoined. Patients were cured in 30 (93.3%), 16 (94.1%), and eight (80.0%) cases in the AC12, AC24 and ACjoined groups, respectively. Unplanned readmission occurred in eight (25.0%), six (35.3%), and two (20.0%) patients in the AC12, AC24 and ACjoined groups, respectively. The outcome of patients with E. faecalis IE treated with AC in OPAT programs relies on an optimization of the delivery of the combination. AC24 exhibit an unexpected rate of failures, however, ACjoined might be an effective alternative which clinical results should corroborate in further studies.

Keywords: Enterococcus faecalis; ampicillin; ceftriaxone; infective endocarditis; outpatient parenteral antibiotic treatment.

Conflict of interest statement

L.F.L.-C. has received unrestricted research funding from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen-Cilag, Merck Sharp & Dohme, and ViiV Healthcare, and consultancy fees and lecture fees from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen-Cilag, and ViiV Healthcare, outside the submitted work. L.E.L.-C. has served as scientific advisor for Angelini, speaker for Angelini, ViiV, Gilead and Correvio, and has served as trainer for ViiV. A.D.A. has served as scientific advisor for Angellini, Novartis, Roche and Cook, speaker for MSD, Pfizer, Angellini, Novartis, Roche and ViiV, and has served as trainer for MSD. The remaining authors have none to declare.

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Source: PubMed

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