IE caused by Enterococci is increasingly becoming common. Antibiotic therapy is ummarized in Table
Antibiotic therapy for due to Enterococcus spp
| Etiologies (usual) | Suggested Regimens (Primary) |
|---|---|
| Ampicillin sensitive (MIC ≤4 mg/L) and non-HLAR (MIC ≤128 mg/L) | Ampicillin with Gentamicin for 4-6 weeks |
| Ampicillin Resistant (β-lactamase producing) and non-HLAR | Ampicillin-sulbactam with Gentamicin for 4-6 weeks |
| Ampicillin Resistant (β-lactamase producing) and HLAR/Risk of nephrotoxicity | Ampicillin-sulbactam with Ceftriaxone for 6 weeks14 |
| Ampicillin Resistant (aPBP) and HLAR/Risk of nephrotoxicity | Vancomycin with gentamicin or daptomycin for 6 weeks |
Ampicillin
200 mg/kg/day in six divided doses (Max dose - 2 g IV in q4h). Native valve: 4-wk therapy recommended for patients with symptoms of illness <3 mo; 6-wk therapy recommended for native valve symptoms >3 mo and for patients with prosthetic valve or prosthetic material. Recommended for patients with creatinine clearance >50 mL/min.
Ampicillin-sulbactam with Gentamicin
(Ampicillin- 150mg/kg/day and Sulbactam 50 mg/kg/day ) in 4 divided doses and Gentamicin 3 mg/kg per 24 h IV or IM in 3 equally divided doses
Ampicillin-sulbactum with ceftriaxone
(Ampicillin- 150mg/kg/day with Sulbactam 50 mg/kg/day )
Vancomycin with gentamicin
Vancomycin 30 mg/kg per 24 h IV in 2 equally divided doses and Gentamicin 3 mg/kg per 24 h IV or IM in 3 equally divided doses
Daptomycin
8-10mg per kg per day
Appropriate antibiotic therapy in IE can have immense impact from stewardship perspective. In a recent study2, following ID consultation, a change to optimal antibiotics was done in 25 of the 32 patients. Of these, de-escalation from meropenem or β-lactam- β-lactamase inhibitor (βL-βLI) combination to ampicillin or ampicillin-sulbactam was done in 12 patients. Vancomycin/teicoplanin was discontinued in 8 patients. Linezolid discontinued in 3 patients. Escalation to meropenem, vancomycin, gentamicin and rifamipicin combination was done in 2 patients with early onset-PVE. No change of antibiotics was done in 4 patients with IE. Following the ID consultation with de-escalation of carbapenem and vancomycin/teicoplanin, the healthcare costs was reduced significantly.