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Antimicrobial Agents and Chemotherapy, May 2001, p. 1387-1393, Vol. 45, No. 5
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

Pedro López,1 Joan Gavaldà,1,* M. Teresa Martin,1 Benito Almirante,1 Xavier Gomis,1 Carlos Azuaje,1 Nuria Borrell,1 Leonor Pou,2 Vicenç Falcó,1 Carles Pigrau,1 and Albert Pahissa1

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.


* 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.


Antimicrobial Agents and Chemotherapy, May 2001, p. 1387-1393, Vol. 45, No. 5
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.5.1387-1393.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.



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