Comparison of different beta-lactam-glycopeptide-gentamicin combinations for an experimental endocarditis caused by a highly beta-lactam-resistant and highly glycopeptide-resistant isolate of Enterococcus faecium

J Infect Dis. 1995 Jan;171(1):106-12. doi: 10.1093/infdis/171.1.106.

Abstract

A synergistic bactericidal effect between penicillin, vancomycin, and gentamicin has been described against enterococci highly resistant to beta-lactams and glycopeptides. Since such a synergy was also observed in vitro between ceftriaxone, teicoplanin, and gentamicin against Enterococcus faecium 70/90, the efficacy of different combinations including penicillin or ceftriaxone, vancomycin or teicoplanin, and gentamicin was compared in vivo in experimental endocarditis. In vitro, all four triple combinations provided a bactericidal effect. In rabbits, after a 5-day treatment, the ceftriaxone-vancomycin-gentamicin combination was the most effective, both in reducing the total bacterial titers and in eradicating the subpopulation resistant to the synergy. Compared with the 5-day regimen, 10- and 20-day regimens of ceftriaxone-vancomycin-gentamicin, each followed by a 3-day antibiotic-free period, increased the number of sterilized animals but failed to avoid the emergence of resistant bacteria, which occurred in 10%-20% of animals.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Ceftriaxone / pharmacology
  • Ceftriaxone / therapeutic use
  • Drug Resistance, Microbial
  • Drug Synergism
  • Drug Therapy, Combination / pharmacology
  • Drug Therapy, Combination / therapeutic use*
  • Endocarditis, Bacterial / drug therapy*
  • Endocarditis, Bacterial / microbiology
  • Enterococcus faecium / drug effects*
  • Female
  • Gentamicins / pharmacology
  • Gentamicins / therapeutic use
  • Gram-Positive Bacterial Infections / drug therapy*
  • Gram-Positive Bacterial Infections / microbiology
  • Penicillins / pharmacology
  • Penicillins / therapeutic use
  • Rabbits
  • Random Allocation
  • Recurrence
  • Teicoplanin / pharmacology
  • Teicoplanin / therapeutic use
  • Vancomycin / pharmacology
  • Vancomycin / therapeutic use

Substances

  • Gentamicins
  • Penicillins
  • Teicoplanin
  • Vancomycin
  • Ceftriaxone