Is Penicillin Alone Effective in Enterococcal Endocarditis?

Thadepalli, Haragopal; Mandal, Ashis Kumar; Rambhatla, Kamalakar; Bach, Vinh T.

doi:10.1159/000238002

Cited by 4 publications

(2 citation statements)

References 21 publications

(33 reference statements)

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“…This observation, together with the finding that better results were obtained with the use of penicillin plus streptomycin, established the idea that combined therapy is preferred (13,82,96,111,125,131,141,175,182,185,226). In animal models of enterococcal endocarditis and by time-kill curves, combination therapy has also been shown to be superior to single-drug regimens such as penicillin, ampicillin, imipenem, and vancomycin (7,35,95,184,200,204).…”

Section: Management Of Enterococcal Infections Therapymentioning

confidence: 91%

The life and times of the Enterococcus

Murray¹

1990

Clin Microbiol Rev

1,704

1,221

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Enterococci are important human pathogens that are increasingly resistant to antimicrobial agents. These organisms were previously considered part of the genus Streptococcus but have recently been reclassified into their own genus, called Enterococcus. To date, 12 species pathogenic for humans have been described, including the most common human isolates, Enterococcus faecalis and E. faecium. Enterococci cause between 5 and 15% of cases of endocarditis, which is best treated by the combination of a cell wall-active agent (such as penicillin or vancomycin, neither of which alone is usually bactericidal) and an aminoglycoside to which the organism is not highly resistant; this characteristically results in a synergistic bactericidal effect. High-level resistance (MIC, greater than or equal to 2,000 micrograms/ml) to the aminoglycoside eliminates the expected bactericidal effect, and such resistance has now been described for all aminoglycosides. Enterococci can also cause urinary tract infections; intraabdominal, pelvic, and wound infections; superinfections (particularly in patients receiving expanded-spectrum cephalosporins); and bacteremias (often together with other organisms). They are now the third most common organism seen in nosocomial infections. For most of these infections, single-drug therapy, most often with penicillin, ampicillin, or vancomycin, is adequate. Enterococci have a large number of both inherent and acquired resistance traits, including resistance to cephalosporins, clindamycin, tetracycline, and penicillinase-resistant penicillins such as oxacillin, among others. The most recent resistance traits reported are penicillinase resistance (apparently acquired from staphylococci) and vancomycin resistance, both of which can be transferred to other enterococci. It appears likely that we will soon be faced with increasing numbers of enterococci for which there is no adequate therapy.

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Section: Management Of Enterococcal Infections Therapymentioning

confidence: 91%

The life and times of the Enterococcus

Murray¹

1990

Clin Microbiol Rev

1,704

1,221

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“…Originally, cases of entero coccal endocarditis had been treated with the classical combination of penicillin G plus streptomycin [13,14]. However, the emergence of high-level streptomycin re sistance [l, 17,18] necessitated combina tion chemotherapy with either penicillin G or ampicillin plus gentamicin [2,17,18,22,31,33] or, in penicillin-allergic pa tients, vancomycin combined with gen tamicin [3,8,10,32], Several investigators utilized rabbits with experimental enterococcal endocarditis to demonstrate the in vivo efficacy of various singular antimi crobial drugs, e.g., penicillin G [25] or gen tamicin [23], or combinations of drugs [17]. The present in vitro study served to examine several established as well as new antimicrobial agents for antienterococcal activity in various combinations and with or without added fresh defibrinated hu man blood.…”

Section: Introductionmentioning

confidence: 99%

<i>Streptococcus faecalis</i>: in vitro Susceptibility to Antimicrobial Drugs, Single and Combined, with and without Defibrinated Human Blood

Traub

Spohr

Bauer³

1986

Chemotherapy

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Ampicillin, fusidic acid, gentamicin, imipenem, mezlocillin, ofloxacin, penicillin G, piperacillin, and vancomycin were examined for inhibitory and bactericidal activity in various broth media against 7 clinical isolates of Streptococcus faecalis. On a weight-for-weight basis, ampicillin, imipenem, mezlocillin, and ofloxacin proved to be more efficacious. All enterococcal isolates were resistant against gentamicin; fusidic acid and vancomycin lacked bactericidal activity. The combinations of either ampicillin, imipenem, mezlocillin, ofloxacin, piperacillin, or vancomycin with a subinhibitory concentration (4 μg/ml) of gentamicin, with or without added 65% (v/v) fresh defibrinated human blood, respectively, yielded additive effects against all enterococcal isolates. The addition of fresh human blood failed to enhance the antienterococcal activity of 4 μg/ml of gentamicin; in contrast, addition of 65% (v/v) fresh or heat-inactivated (56°C, 30 min) normal rabbit, bovine, and human sera augmented the activity of gentamicin, an effect that was ablated through the addition of either 0.005 M DTT or 0.01 M MgCl₂ + 0.01 M EGTA + 0.01 M CaCl₂, supplements known to antagonize human serum β-lysin, but not lysozyme activity.

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Aminoglycoside Resistant Enterococcal Endocarditis

Eliopoulos

1993

Infectious Disease Clinics of North America

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Is Penicillin Alone Effective in Enterococcal Endocarditis?

Cited by 4 publications

References 21 publications

The life and times of the Enterococcus

The life and times of the Enterococcus

<i>Streptococcus faecalis</i>: in vitro Susceptibility to Antimicrobial Drugs, Single and Combined, with and without Defibrinated Human Blood

Aminoglycoside Resistant Enterococcal Endocarditis

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