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Enterococcal endocarditis--a case treated with teicoplanin and amoxycillin
P L Botha1, M C Struwig, W de Vries
1Department of Medical Microbiology, Universitas Hospital, Bloemfontein.
Summary
This study found that a combination of teicoplanin and amoxycillin effectively treated vancomycin-resistant Enterococcus faecalis endocarditis. This combination therapy proved bactericidal, leading to full patient recovery.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Investigating effective treatments for endocarditis caused by vancomycin-resistant Enterococcus faecalis.
- Addressing challenges in treating infections with bacteria resistant to standard antibiotic therapies.
Observation:
- A patient with a childhood aortic valve defect developed endocarditis due to vancomycin-resistant Enterococcus faecalis post-splenectomy.
- A perivalvular abscess was identified during surgery.
- In vitro studies guided the selection of postoperative antibacterial agents.
Findings:
- Teicoplanin and amoxycillin, both cell-wall-active agents, demonstrated bactericidal activity in vitro at achievable serum trough levels.
- The combination of teicoplanin (minimal bactericidal concentration: 250 µg/ml) and amoxycillin (minimal bactericidal concentration: 64 µg/ml) successfully eradicated the infection.
- The synergistic action at different bacterial cell wall synthesis sites was key to treatment efficacy.
Implications:
- This combination therapy offers a viable treatment option for severe endocarditis caused by vancomycin-resistant Enterococcus faecalis.
- Highlights the importance of in vitro susceptibility testing and serum activity in guiding antibiotic selection for complex infections.
- Suggests that combining agents with different mechanisms of action can overcome antibiotic resistance.
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