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Antibiotic synergism in enterococcal endocarditis

J Carrizosa, D Kaye

    The Journal of Laboratory and Clinical Medicine
    |July 1, 1976
    PubMed
    Summary
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    Treatment with penicillin plus gentamicin or sisomicin showed a significant advantage over penicillin plus streptomycin for established enterococcal endocarditis caused by streptomycin-resistant strains in rabbits.

    Area of Science:

    • Infectious Diseases
    • Pharmacology
    • Microbiology

    Background:

    • Enterococcal endocarditis poses treatment challenges, particularly with aminoglycoside-resistant strains.
    • Streptomycin resistance in enterococci necessitates evaluating alternative aminoglycoside treatment options.

    Purpose of the Study:

    • To compare the efficacy of different antibiotic combinations in treating experimental enterococcal endocarditis.
    • To assess the impact of streptomycin resistance on treatment outcomes with procaine penicillin, gentamicin, and sisomicin.

    Main Methods:

    • Experimental left-sided endocarditis was induced in rabbits using streptomycin-sensitive and streptomycin-resistant enterococcal strains.
    • Animals were treated with procaine penicillin alone, or in combination with streptomycin, gentamicin, or sisomicin at varying time points post-infection.

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  • Bacterial burden in vegetations was quantified as log10 colony forming units per gram (log CFU).

    • Main Results:

    • For streptomycin-sensitive strains, all combinations were effective, with procaine penicillin alone showing higher bacterial counts.
    • For streptomycin-resistant strains, early treatment (6 hours) showed similar efficacy across combinations.
    • Established infections (24 hours or 3 days) with resistant strains demonstrated superior outcomes with procaine penicillin plus gentamicin or sisomicin compared to procaine penicillin plus streptomycin.

    Conclusions:

    • Gentamicin and sisomicin offer a significant advantage over streptomycin when combined with penicillin for treating established enterococcal endocarditis caused by streptomycin-resistant strains.
    • The choice of aminoglycoside is critical in managing enterococcal endocarditis, especially in the presence of resistance.
    • Early intervention is crucial, but combination therapy choice significantly impacts outcomes in more advanced disease.