Is Ampicillin + Ceftriaxone as safe and effective as Ampicillin + Gentamicin in the treatment of Enterococcus faecalis endocarditis?

J Infect. 2018 Jun 30

Contributed by Dr Abi Manesh

Ampicillin + Ceftriaxone (AC) is an attractive option in the treatment of Enterococcus faecalis endocarditis because of the potential renal safety and prevalent gentamicin resistance. In this retrospective review from Mayo clinic, both the options were equally efficacious with similar 1 year mortality and relapse rates. Also AC therapy was associated with less renal toxicity (greater increase in serum creatinine at end of therapy (median difference, +0.4 [0.2, 0.8] vs -0.2 [-0.3, 0.1] mg/dL, P≤.001).

Of course there are no RCTs in this area; but accumulating evidence shows the safety and efficacy of this regimen which is especially attractive in older patients and those on OPAT.