Abstract
Previous in vitro studies demonstrating that the penicillinase-resistant penicillins act synergistically in combination with gentamicin against some enterococci have suggested that these combinations might be effective therapy for enterococcal infections in vivo. To determine the in vivo effectiveness of such combinations, we treated rabbits with enterococcal endocarditis with gentamicin and either nafcillin, oxacillin, or methicillin. Despite doses of the penicillins equivalent to 12 or 24 g/day in a 70-kg patient, the percentage of animals in each treatment group with sterile valves at autopsy after spontaneous death or sacrifice after 21 days of therapy was low. High-dose therapy with the penicillins did not significantly increase survival over the low-dose treatment groups. Thus, it seems prudent to include penicillin with a penicillinase-resistant penicillin and gentamicin as the initial therapy of patients with endocarditis possibly caused by enterococci.
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Selected References
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- Banks T., Fletcher R., Ali N. Infective endocarditis in heroin addicts. Am J Med. 1973 Oct;55(3):444–451. doi: 10.1016/0002-9343(73)90201-5. [DOI] [PubMed] [Google Scholar]
- Garrison P. K., Freedman L. R. Experimental endocarditis I. Staphylococcal endocarditis in rabbits resulting from placement of a polyethylene catheter in the right side of the heart. Yale J Biol Med. 1970 Jun;42(6):394–410. [PMC free article] [PubMed] [Google Scholar]
- Glew R. H., Millering R. S., Jr, Wennersten C. Comparative synergistic activity of nafcillin, oxacillin, and methicillin in combination with gentamicin against. Antimicrob Agents Chemother. 1975 Jun;7(6):828–832. doi: 10.1128/aac.7.6.828. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marier R. L., Joyce N., Andriole V. T. Synergism of oxacillin and gentamicin against enterococci. Antimicrob Agents Chemother. 1975 Nov;8(5):571–573. doi: 10.1128/aac.8.5.571. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ramsey R. G., Gunnar R. M., Tobin J. R., Jr Endocarditis in the drug addict. Am J Cardiol. 1970 May;25(5):608–618. doi: 10.1016/0002-9149(70)90600-4. [DOI] [PubMed] [Google Scholar]
- Reiner N. E., Gopalakrishna K. V., Lerner P. I. Enterococcal endocarditis in heroin addicts. JAMA. 1976 Apr 26;235(17):1861–1863. [PubMed] [Google Scholar]
- Watanakunakorn C., Glotzbecker C. Comparative in vitro activity of nafcillin, oxacillin, and methicillin in combination with gentamicin and tobramycin against enterococci. Antimicrob Agents Chemother. 1977 Jan;11(1):88–91. doi: 10.1128/aac.11.1.88. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weinstein A. J., Lentnek A. L. Cephalosporin-aminoglycoside synergism in experimental enterococcal endocarditis. Antimicrob Agents Chemother. 1976 Jun;9(6):983–987. doi: 10.1128/aac.9.6.983. [DOI] [PMC free article] [PubMed] [Google Scholar]