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Outpatient continuous-infusion benzylpenicillin combined with either gentamicin or ceftriaxone for enterococcal

Simon Briggs1, Matthew Broom1, Eamon Duffy1

  • 1Infectious Disease Unit, Auckland City Hospital, Auckland, New Zealand.

The Journal of Antimicrobial Chemotherapy
|May 11, 2021
PubMed
Abstract

Insights

Continuous-infusion benzylpenicillin with daily gentamicin or ceftriaxone is effective for outpatient enterococcal endocarditis. Ceftriaxone demonstrated fewer adverse antibiotic effects compared to gentamicin.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Cardiology

Background:

  • Enterococcal endocarditis treatment often requires complex dosing regimens challenging for outpatient settings.
  • Continuous-infusion benzylpenicillin with once-daily synergistic antibiotics simplifies outpatient care.
  • Commonly utilized regimens in New Zealand involve benzylpenicillin with either gentamicin or ceftriaxone.

Purpose of the Study:

  • To evaluate the therapeutic success of outpatient enterococcal endocarditis treatment.
  • To assess the incidence and types of adverse antibiotic effects associated with these regimens.
  • To compare the efficacy and safety of gentamicin versus ceftriaxone as synergistic agents.

Main Methods:

  • Retrospective observational case series of patients aged 15 years and older.
  • Inclusion criteria: diagnosis of enterococcal endocarditis and at least 14 days of outpatient continuous-infusion benzylpenicillin with gentamicin or ceftriaxone.
  • Data collected on treatment outcomes, relapse rates, and adverse antibiotic effects.

Main Results:

  • Forty-three episodes of enterococcal endocarditis were analyzed.
  • Overall cure rate was 76%, with 7% experiencing relapse and 17% requiring suppressive oral therapy.
  • Significantly more adverse effects were observed with gentamicin (35%) compared to ceftriaxone (0%) (P < 0.01).

Conclusions:

  • Outpatient continuous-infusion benzylpenicillin combined with once-daily gentamicin or ceftriaxone is generally effective for enterococcal endocarditis.
  • Ceftriaxone is favored over gentamicin as the initial synergistic antibiotic due to a significantly lower rate of adverse effects.
  • These findings support the use of ceftriaxone in simplified outpatient treatment regimens.

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