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Outpatient parenteral antimicrobial therapy in Enterococcus faecalis infective endocarditis
M V Gil-Navarro1, L E Lopez-Cortes2, R Luque-Marquez3
1Unidad Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio, Sevilla, Spain.
Journal of Clinical Pharmacy and Therapeutics
|October 15, 2017
Summary
This study shows that a simplified outpatient regimen of ampicillin and ceftriaxone can effectively treat Enterococcus faecalis infective endocarditis, allowing patients to receive care at home. This approach offers a safe and viable alternative to prolonged hospitalization.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Enterococcus faecalis is a common cause of infective endocarditis (IE).
- Current standard treatment involves a lengthy 6-week hospitalization with intravenous ampicillin and ceftriaxone, requiring two infusion pumps.
- This regimen is often not suitable for outpatient parenteral antimicrobial therapy (OPAT) programs due to complexity.
Purpose of the Study:
- To design and evaluate a simplified, home-based continuation regimen for E. faecalis IE.
- To enable treatment of E. faecalis IE patients within an OPAT setting, reducing hospitalization duration.
Main Methods:
- A retrospective analysis of patients in an OPAT program between July 2012 and March 2017.
- Selected patients with E. faecalis IE received a continuation regimen of ampicillin (12 g daily, 2 g/4 h) and ceftriaxone (4 g once daily).
- This regimen was administered using a programmable pump for ampicillin and a short infusion for ceftriaxone.
Main Results:
- Four patients with E. faecalis IE were treated with the novel OPAT regimen.
- Patients received a median of 22.5 days of outpatient treatment after initial hospitalization.
- All patients achieved clinical and microbiological cure with no recurrences or complications during a median 365-day follow-up.
Conclusions:
- A simplified outpatient regimen of ampicillin (2 g/4 h) plus once-daily ceftriaxone (4 g) is effective and safe for treating E. faecalis IE.
- This regimen allows for successful home-based treatment, similar to the standard in-hospital approach.
- The simplified dosing of ceftriaxone leverages its pharmacokinetic profile for effective synergy with ampicillin in vegetations.
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