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Relapsing native-valve enterococcal endocarditis: a unique cure with oral ciprofloxacin combination drug therapy
H L Sacher1, W C Miller, S W Landau
1Department of Internal Medicine, Massapequa General Hospital, Seaford, Long Island, New York 11783.
Journal of Clinical Pharmacology
|August 1, 1991
Summary
Enterococcal endocarditis is difficult to treat and often relapses, especially with resistant strains. A novel combination therapy including oral ciprofloxacin achieved a cure in a challenging relapsing case.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Enterococcal endocarditis is a refractory infection, often requiring combination aminoglycoside therapy.
- High-level streptomycin resistance and emerging beta-lactamase-producing strains complicate treatment.
- Conventional therapies have toxicities and limited efficacy against resistant enterococci.
Observation:
- A case of relapsing enterococcal endocarditis caused by a streptomycin-resistant, non-beta-lactamase-producing S. faecalis strain is presented.
- Relapses occurred despite standard beta-lactam-gentamicin treatment, even with favorable in vitro data.
- The patient had high-level streptomycin resistance but remained susceptible to gentamicin.
Findings:
- In vitro studies suggest broth macrodilution and agar dilution are reliable for predicting outcomes.
- Oral ciprofloxacin in a combination regimen was successfully used to achieve a cure.
- This represents the first reported instance of using oral ciprofloxacin for this specific enterococcal endocarditis presentation.
Implications:
- Novel therapeutic strategies are urgently needed due to rising antimicrobial resistance and conventional therapy toxicities.
- Ciprofloxacin-based combination regimens may offer a promising alternative for difficult-to-treat enterococcal endocarditis.
- Further clinical investigation is warranted to establish the efficacy and safety of ciprofloxacin in enterococcal endocarditis protocols.