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Antimicrobial Agents and Chemotherapy, May 2001, p. 1387-1393, Vol. 45, No. 5
Infectious Diseases Research Laboratory,
Infectious Diseases Division,1 and
Biochemistry Laboratory, Hospital General Vall
d'Hebron,2 Universitat Autònoma de
Barcelona, Barcelona, Spain
Received 17 July 2000/Returned for modification 12 November
2000/Accepted 8 February 2001
With the aim of investigating home therapy for enterococcal
endocarditis, we compared the efficacy of teicoplanin
combined with gentamicin given once a day or in three daily doses
(t.i.d.) with the standard treatment, ampicillin plus gentamicin
administered t.i.d., for treating experimental enterococcal
endocarditis. The antibiotics were administered by using "human-like
pharmacokinetics" (H-L), i.e, pharmacokinetics like those in humans,
that simulated the profiles of these drugs in human serum. Animals with
catheter-induced endocarditis were infected intravenously with
108 CFU of Enterococcus faecalis EF91 (MICs and
MBCs of ampicillin, gentamicin, and teicoplanin, 0.5 and 32, 16 and 32, and 0.5 and 1 µg/ml, respectively) and were treated for 3 days with
ampicillin H-L at 2 g every 4 h plus gentamicin H-L at 1 mg/kg every 8 h, or teicoplanin H-L at 10 mg/kg every 24 h,
alone or combined with gentamicin, administered at dose of H-L at 1 mg/kg every 8 h or H-L at 4.5 mg/kg every 24 h. The results
of therapy for experimental endocarditis due to EF91 showed that
teicoplanin alone was as effective as ampicillin alone in reducing the
bacterial load (P > 0.05). The combination of
ampicillin or teicoplanin with gentamicin was more effective than the
administration of both drugs alone in reducing the
log10CFU/gram of aortic vegetation (P < 0.01 and P < 0.05, respectively). Teicoplanin
plus gentamicin H-L at 4.5 mg/kg, both administered every 24 h, showed an efficacy equal to the "gold standard," ampicillin plus
gentamicin H-L at 1 mg/kg t.i.d. (P > 0.05).
Increasing the interval of administration of gentamicin to a
single daily dose combined with teicoplanin resulted in a reduction of
bacteria in the vegetations equivalent to that achieved with the
recommended regimen of ampicillin plus thrice-daily gentamicin in the
treatment of experimental endocarditis due to E. faecalis.
Teicoplanin plus gentamicin, both administered once a day, may be
useful home therapy for selected cases of enterococcal endocarditis.
0066-4804/01/$04.00+0 DOI: 10.1128/AAC.45.5.1387-1393.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.
Efficacy of Teicoplanin-Gentamicin Given Once a Day
on the Basis of Pharmacokinetics in Humans for Treatment of
Enterococcal Experimental Endocarditis
*
Corresponding author. Mailing address: Servei de
Malalties Infeccioses, Hospital General Vall d'Hebron, Hospitals Vall
d'Hebron, Avda. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
Phone: 34-93-4894033. Fax: 34-93-2746057. E-mail:
gavalda{at}hg.vhebron.es.
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