Antibiotic Management of Outpatients with Endocarditis Due to Penicillin-Susceptible Streptococci

Stamboulián, Daniel; Bonvehí, Pablo; Arévalo, Cecilia E; Bologna, Rosa; Cassetti, Isabel; Scilingo, Viviana M.; Efrón, Ernesto

doi:10.1093/clinids/13.supplement_2.s160

Cited by 109 publications

(64 citation statements)

References 7 publications

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“…Selected patients with endocarditis are also candidates for OPAT [19]. There is a significant experience in treating nonenterococcal endocarditis on an outpatient basis, usually with once-daily ceftriaxone and sometimes without hospitalization [20][21][22]. However, patients with endocarditis who have prosthetic valves, persistently positive blood culture results, poorly controlled congestive heart failure, large vegetations (110 mm in length), recurrent embolic events, Staphylococcus aureus etiology, or conduction abnormalities are at increased risk for complications that may be more quickly recognized and treated in the hospital.…”

Section: Patient Evaluation and Selectionmentioning

confidence: 99%

Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy

Tice

Rehm

Dalovisio

et al. 2004

Journal of Infusion Nursing

124

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EXECUTIVE SUMMARYThese guidelines were formulated to assist physicians and other health care professionals with various aspects of the administration of outpatient parenteral antimicrobial therapy (OPAT). Although there are many reassuring retrospective studies on the efficacy and safety of OPAT, few prospective studies have been conducted to compare the risks and outcomes for patients who receive treatment as outpatients rather than as inpatients. Because truly evidence-based studies are lacking, the present guidelines are formulated from the collective experience of the committee members and advisors from related organizations.Important aspects of OPAT are described in the text and tables and include the following:1. The literature supports the effectiveness of OPAT for a wide variety of infections (table 1 and the Appendix).2. A thorough assessment of the patient's general medical condition, the infectious process, and the home situation is necessary before starting therapy (table 2) 3. Prescribing physicians should be aware of a number of aspects of OPAT which distinguish it from

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Section: Patient Evaluation and Selectionmentioning

confidence: 99%

Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy

Tice

Rehm

Dalovisio

et al. 2004

Journal of Infusion Nursing

124

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“…Two recent developments may allow more convenient and safer treatment ofthis condition. First, a single daily dose of ceftriaxone (a cephalosporin with a prolonged serum half-life) given for 4 weeks has been found to be effective against streptococcal endocarditis [4,5]. This regimen has been used successfully on an outpatient basis and without a permanent iv catheter.…”

mentioning

confidence: 99%

Treatment of Streptococcal Endocarditis with a Single Daily Dose of Ceftriaxone and Netilmicin for 14 Days: A Prospective Multicenter Study

Francioli¹,

Ruch²,

Stamboulián³

1995

Clinical Infectious Diseases

128

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A 2-week course of ceftriaxone (2 g) plus netilmicin (4 mglkg), administered as one short daily iv infusion, was evaluated for the treatment of streptococcal endocarditis in an open multicenter study. Of the 52 patients, 31 were infected with viridans streptococci, 18 with Streptococcus bovis, two with Gemella morbillorum, and one with group C Streptococcus; 48 patients were assessable.Infection was cured in 42 cases, 35 treated medically and seven treated both medically and surgically. Five patients died without evidence of active infection, and one relapsed. The bacteriologic failure was due to a strain of G. morbillorum against which no synergy of ceftriaxone and netilmicin was evident in vitro. The serum creatinine level increased during treatment in four cases, all involving patients >65 years old who had renal risk factors; in two of these cases, values did not return to baseline during follow-up. Of 40 patients assessed for auditory function, only one developed decreased perception of borderline significance. Other adverse reactions were mild. This regimen was efficacious, safe, and cost-effective for the treatment of streptococcal endocarditis. However, it must be used with caution for patients with preexisting renal impairment or concomitant exposure to other potentially nephrotoxic agents.Four weeks of treatment with iv penicillin alone or 2 weeks oftreatment with iv penicillin plus an aminoglycoside are effective for streptococcal endocarditis [1,2]. However, such regimens require several daily injections, and the use of aminoglycosides carries a risk of renal toxicity and ototoxicity [2,3]. Two recent developments may allow more convenient and safer treatment ofthis condition. First, a single daily dose of ceftriaxone (a cephalosporin with a prolonged serum half-life) given for 4 weeks has been found to be effective against streptococcal endocarditis [4,5]. This regimen has been used successfully on an outpatient basis and without a permanent iv catheter. Second, recent experimental and clinical evidence has suggested that administration of the total daily dose of an aminoglycoside in a single injection is as effective as administration of the same amount of drug in two or three injections and causes equal or less toxicity [6][7][8][9]. Indeed, in the treatment of experimental streptococcal endocarditis, when given in a single daily dose rather than as multiple doses, aminoglycosides were just as synergistic with ,B-Iactam agents such as penicillin and ceftriaxone [10-13].The purpose of the multicenter study reported herein was to test prospectively the efficacy and safety of a 2-week course of therapy for streptococcal (nonenterococcal) endocarditis with a regimen consisting of ceftriaxone plus netilmicin given once a day. The study was noncomparative since streptococcal endocarditis is a rare disease and the outcome of treatment with penicillin is well known. The efficacy of penicillin is so high that it would have been impossible to recruit enough patients to exclude a type II error. Patients and ...

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“…Thus, the results presented here provide a bacterial counts in infected vegetarationale for clinical trials of this once-a-day dosing regimen in the treatment of streptococcal but nonenterococcal endocarditis. On the basis of the good results obtained with CRO as monotherapy (9,28) and the demonstrated in vivo synergism with one daily dose of NET in the experiments described here, a short course of therapy (e.g., 2 weeks) could be envisioned, with the associated advantages of cost and convenience.…”

Section: Discussionmentioning

confidence: 99%

“…Two recent developments may allow for more convenient and safer treatment. First, a single daily dose of ceftriaxone (CRO) administered for 4 weeks has been found to be effective and has allowed treatment of a substantial number of patients on an outpatient basis and without a permanent venous catheter (9,28). Second, recent experimental and clinical evidence has suggested that the administration of a total daily dose of an aminoglycoside in one daily injection is as effective as and is potentially less toxic than a regimen of two or three daily doses (1,10,17,23,29,31,33).…”

mentioning

confidence: 99%

Simulated human serum profiles of one daily dose of ceftriaxone plus netilmicin in treatment of experimental streptococcal endocarditis

Blatter

Flückiger

Entenza

et al. 1993

Antimicrob Agents Chemother

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We performed experiments in rats aimed at determining whether a combination of ceftriaxone (CRO) and netilmicin (NET), by using once-daily administration in rats, which simulated profiles of drug in human serum, was more effective than either agent alone in the treatment of endocarditis caused by viridans group streptococci. A programmable infusion pump system enabled the production of profiles of CRO in serum that simulate those found in humans after the intravenous administration of 2 g. The subcutaneous administration of 18 mg of NET per kg of body weight produced levels in the sera of rats comparable to those after the intravenous administration of a dose of 5 mg of NET per kg in humans. Rats with catheter-induced aortic vegetations were infected intravenously with two test strains, a CRO-susceptible Streptococcus sanguis strain (MICs of CRO and NET, 0.064 and 8 mg/liter, respectively) and a relatively CRO-resistant Streptococcus mitis strain (MICs of CRO and NET, 2 and 8 mg/liter, respectively). Against both strains, the combination of CRO and NET was synergistic in vitro as determined by time-kill curves. Treatment of rats was started 48 h postinfection and lasted for 3 days. CRO alone was effective against the susceptible strain (P < 0.001 compared with control animals) but was not effective against the resistant organism. A significantly enhanced antibacterial activity of the CRO-NET combination in reducing the valvular bacterial counts was observed with both test strains (P < 0.001). The synergistic effect was obtained with a single daily injection of NET which provided detectable levels in serum for only 8 h, suggesting that in vivo synergism in the treatment of infections caused by viridans group streptococci can be obtained without 24 h of aminoglycoside coverage. These experimental data might provide a rationale for clinical trials of a once-a-day dosing regimen in the treatment of streptococcal but nonenterococcal endocarditis.The regimen of penicillin for 4 weeks or penicillin plus two injections of an aminoglycoside per day for 2 weeks is effective for the treatment of endocarditis caused by viridans group streptococci. However, both regimens require several injections per day, and the addition of the aminoglycoside can be toxic in elderly patients or in those with impaired renal function. Two recent developments may allow for more convenient and safer treatment. First, a single daily dose of ceftriaxone (CRO) administered for 4 weeks has been found to be effective and has allowed treatment of a substantial number of patients on an outpatient basis and without a permanent venous catheter (9, 28). Second, recent experimental and clinical evidence has suggested that the administration of a total daily dose of an aminoglycoside in one daily injection is as effective as and is potentially less toxic than a regimen of two or three daily doses (1,10,17,23,29,31,33). Thus, it is conceivable that a combination of CRO plus one daily dose of netilmicin (NET), administered one after the other in a single in...

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Antibiotic Management of Outpatients with Endocarditis Due to Penicillin-Susceptible Streptococci

Cited by 109 publications

References 7 publications

Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy

Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy

Treatment of Streptococcal Endocarditis with a Single Daily Dose of Ceftriaxone and Netilmicin for 14 Days: A Prospective Multicenter Study

Simulated human serum profiles of one daily dose of ceftriaxone plus netilmicin in treatment of experimental streptococcal endocarditis

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