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

Laura Herrera-Hidalgo1,2, Jose Manuel Lomas-Cabezas2, Luis Eduardo López-Cortés3

  • 1Unidad de Farmacia, Hospital Universitario Virgen del Rocío/CSIC/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain.

Journal of Clinical Medicine
|January 11, 2022
PubMed

Insights

Ampicillin plus ceftriaxone (AC) regimens for Enterococcus faecalis infective endocarditis (IE) are challenging in outpatient parenteral antibiotic treatment (OPAT). The ACjoined regimen shows promise as an effective alternative for OPAT, warranting further investigation.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Pharmacology

Background:

  • Ampicillin plus ceftriaxone (AC) is a standard inpatient treatment for Enterococcus faecalis infective endocarditis (IE).
  • Standard AC regimens require frequent dosing, posing challenges for outpatient parenteral antibiotic treatment (OPAT) programs.
  • Alternative AC dosing strategies, including AC24 (once-daily high-dose ceftriaxone) and ACjoined (co-diluted, 4-hourly bolus), have been proposed for OPAT.

Purpose of the Study:

  • To evaluate the clinical effectiveness and safety of three different ampicillin plus ceftriaxone (AC) regimens for treating Enterococcus faecalis infective endocarditis (IE).
  • To compare the outcomes of AC12 (standard inpatient), AC24, and ACjoined regimens in patients with E. faecalis IE.

Main Methods:

  • Retrospective analysis of prospectively collected data from 59 patients with E. faecalis IE.
  • Patients were treated with one of three AC regimens: AC12 (n=32), AC24 (n=17), or ACjoined (n=10).
  • Outcomes assessed included cure rates, relapses, and unplanned readmissions.

Main Results:

  • Overall cure rates were high across all groups: AC12 (93.3%), AC24 (94.1%), and ACjoined (80.0%).
  • The AC24 regimen showed a significantly higher relapse rate (29.4%) compared to ACjoined (10.0%).
  • Unplanned readmission rates varied: AC12 (25.0%), AC24 (35.3%), and ACjoined (20.0%).

Conclusions:

  • Optimizing the delivery of ampicillin plus ceftriaxone combinations is crucial for successful E. faecalis IE treatment in OPAT settings.
  • The AC24 regimen demonstrated an unexpected high failure rate.
  • The ACjoined regimen may represent an effective alternative for E. faecalis IE in OPAT, requiring further validation in prospective studies.

Keywords:
Enterococcus faecalisampicillinceftriaxoneinfective endocarditisoutpatient parenteral antibiotic treatment

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