Do you recommend the use of ampicillin/ceftriaxone for prosthetic valve endocarditis due to ampicillin-susceptible Enterococcus faecium?

The prognosis for Enterococcus faecalis endocarditis is generally better than that for Enterococcus faecium, primarily due to antibiotic susceptibility patterns. It is fortunate to have an ampicillin-susceptible strain of E. faecium in this case of prosthetic valve infective endocarditis. In general...

Since even ampicillin-susceptible Enterococci lack robust autolytic enzymes, ampicillin is actually bacteriostatic against this organism even with prolonged incubation. For this reason, I like a 4-6 week combination treatment with amp+CTR, which is bactericidal since these antibiotics target differe...

Agree with ampicillin/penicillin + ceftriaxone for most patients (there are often complexities to this decision). There was decent evidence for this, even a decade ago, referenced in the IDSA/AHA infective endocarditis guidelines (Baddour et al., PMID 26373316), where AMP + CRO is a class IIa, level...

I do not recommend adding ceftriaxone as a second agent for Enterococcus endocarditis, as this approach is not supported by evidence-based medicine. No large randomized trials have demonstrated that dual therapy is superior to ampicillin monotherapy.

I would use dual therapy. Prior to Dr. Moellering's seminal work in this area describing synergy between penicillin and streptomycin, the cure rate for enterococcus endocarditis clinically was in the 40% range. This nearly doubled with the use of synergistic treatment using penicillin and streptomyc...