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January 8, 1992, Vol 267, No. 2 >
ARTICLE | January 8, 1992

Treatment of Streptococcal Endocarditis With a Single Daily Dose of Ceftriaxone Sodium for 4 Weeks: Title and subTitle BreakEfficacy and Outpatient Treatment Feasibility FREE

Andreas Gerber, MD; Jean-Pierre Thys, MD; Rolf Hoigné, MD; Jérôme Etienne, MD; Patrick Francioli, MD
[+] Author Affiliations

A complete list of the participants in the Infective Endocarditis Study Group appears at the end of this article.

Reprint requests to Départment de Médecine Interne, Division des Maladies Infectieuses, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Le, Switzerland (Dr Francioli).


JAMA. 1992;267(2):264-267. doi:10.1001/jama.1992.03480020074034
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References

Objective.  —To evaluate the efficacy and safety of ceftriaxone sodium in the treatment of streptococcal endocarditis.

Design.  —An open, multicenter, noncomparative study with a follow-up of patients for 4 months to 5 years.

Setting.  —Internal medicine wards and outpatient clinics of hospitals of various sizes in three European countries.

Patients.  —Fifty-nine patients with defined criteria for streptococcal endocarditis.

Intervention.  —Ceftriaxone sodium administered at a once-daily dose of 2 g for 4 weeks.

Main Outcome Measures.  —Clinical outcome and microbiological cure rate.

Results.  —Among the 59 patients, 55 completed the treatment and were followed up for 4 months to 5 years. No patients showed evidence of relapse. Treatment was completely uneventful in 42 patients (71%). A cardiac valve was replaced in four patients (7%) receiving antimicrobial therapy and in six patients (10%) who had completed antimicrobial therapy. One of the 10 valves taken for culture at surgery was positive, but only for microorganisms that were different from the microorganism isolated before the treatment. The treatment had to be interrupted in four patients because of drug allergy. Other side effects were mild except for two cases of reversible neutropenia. The treatment was easy to administer: 27 patients (46%) had no permanent intravenous catheter at any time, seven patients (12%) had such a catheter for less than 4 days. Twenty-three patients (39%) were discharged from the hospital less than 2 weeks after admission.

Conclusions.  —Ceftriaxone sodium administered at a once-daily dose of 2 g appears to be an effective and safe treatment of streptococcal endocarditis. In hospitals, this agent may be more convenient to administer than penicillin G with or without aminoglycosides. Some patients may even be treated as outpatients.(JAMA. 1992;267:264-267)

REFERENCES

1 +
Bisno AL, Dismukes WE, Durack DT, et al.  Antimicrobial treatment of infective endocarditis due to viridans streptococci, enterococci, and staphylococci. JAMA . 1989;;261:1471-1477.
2 +
Wilson WR, Geraci JE.  Treatment of streptococcal infective endocarditis. Am J Med . 1985;;78( (suppl 6B) ):128-137.
3 +
Etienne J, Vandenesch F, Fauvel JP, et al.  Susceptibilities to ceftriaxone of streptococcal strains associated with infective endocarditis. Chemotherapy . 1989;;35:355-359.
4 +
Patel IH, Kaplan SA.  Pharmacokinetic profile of ceftriaxone. Am J Med . 1984;;77:17-25.
5 +
Richards DM, Heel RC, Brogden RN, Speight TM, Avery GS.  Ceftriaxone: a review of its antibacterial activity, pharmacological proprieties, and therapeutic use. Drugs . 1984;;27:469-527.
6 +
Baumgartner JD, Glauser MP.  Single daily dose treatment of severe refractory infections with ceftriaxone: cost savings and possible parenteral outpatient treatment. Arch Intern Med . 1984;; 143:1868-1873.
7 +
Russo TA, Cook S, Gorbach SL.  Intramuscular ceftriaxone in home parenteral therapy. Antimicrob Agents Chemother . 1988;;32:1439-1440.
8 +
Bradley JS, Ching DK, Philips SE.  Outpatient therapy of serious pediatric infections with ceftriaxone. Pediatr Infect Dis J . 1988;;7:160-164.
9 +
Von Reyn CF, Levy BS, Arbeit RD, et al.  Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med . 1981;;94:505-518.
10 +
Wolfe JC, Johnson WD Jr.  Penicillin-sensitive streptococcal endocarditis in vitro and clinical observations on penicillin-streptomycin therapy. Ann Intern Med . 1974;;81:178-181.
11 +
Karchmer AW, Moellering RC, Maki DG, Swartz MN.  Single-antibiotic therapy for streptococcal endocarditis. JAMA . 1979;;241:1801-1806.
12 +
Malacoff RF, Frank E, Andriole VT.  Streptococcal endocarditis (nonenterococcal, non-group A) single vs combination therapy. JAMA . 1979;; 241:1807-1810.
13 +
Stamboulian D, Bonvehi P, Arevalo C, et al.  Antiobiotic management of outpatients with endocarditis due to penicillin-susceptible streptococci. Rev Infect Dis . 1991;;13:( (suppl 2) )160-163.
14 +
Wilson WR, Thompson RL, Wilkowske CJ, et al.  Short-term therapy for streptococcal infective endocarditis: combined intramuscular administration of penicillin and streptomycin. JAMA . 1981;;245:360-363.
15 +
Olaison L, Alestig K.  A prospective study of neutropenia induced by high doses of betalactam antibiotics. J Antimicrob Chemother . 1990;;25:449-453.
16 +
Pfeifer JF, Lipton MJ, Oury JH, Angell WW, Hultgren HN.  Case reports: acute coronary embolism complicating bacterial endocarditis: operative treatment. Am J Cardiol . 1976;;37:920-922.
17 +
Greenberg BH, Hoffman P, Schiller NB, Miller M, Chatterjee K.  Sudden death in infective endocarditis. Chest . 1977;;71:794-795.
18 +
Pruitt AA, Rubin RH, Karchmer AW, Duncan GW.  Neurologic complications of bacterial endocarditis. Medicine . 1978;;57:329-343.
19 +
Salgado AV, Furlan AJ, Keys TF, Nichols TR, Beck GJ.  Neurologic complications of endocarditis: a 12-year experience. Neurology . 1989;;39:173-178.
20 +
Paschalis C, Pugsley W, John E, Harrison MJG.  Rate of cerebral embolic events in relation to antibiotic and anticoagulant therapy in patients with bacterial endocarditis. Eur Neurol . 1990;; 30:87-89.
21 +
Jaffe WM, Morgan DE, Pearlman AS, Otto CM.  Infective endocarditis, 1983-1988: echocardiographic findings and factors influencing morbidity and mortality. J Am Coll Cardiol . 1990;;15:1227-1233.
22 +
Mugge A, Daniel WG, Frank G, Lichtlen PR.  Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size detemined by the transthoracic and the transesophageal approach. J Am Coll Cardiol . 1989;; 14:631-638.
23 +
Dajani AS, Bisno AL, Chung KJ, et al.  Prevention of bacterial endocarditis: recommendations by the American Heart Association. JAMA . 1990;; 264:2919-2922.

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1 +
Bisno AL, Dismukes WE, Durack DT, et al.  Antimicrobial treatment of infective endocarditis due to viridans streptococci, enterococci, and staphylococci. JAMA . 1989;;261:1471-1477.
2 +
Wilson WR, Geraci JE.  Treatment of streptococcal infective endocarditis. Am J Med . 1985;;78( (suppl 6B) ):128-137.
3 +
Etienne J, Vandenesch F, Fauvel JP, et al.  Susceptibilities to ceftriaxone of streptococcal strains associated with infective endocarditis. Chemotherapy . 1989;;35:355-359.
4 +
Patel IH, Kaplan SA.  Pharmacokinetic profile of ceftriaxone. Am J Med . 1984;;77:17-25.
5 +
Richards DM, Heel RC, Brogden RN, Speight TM, Avery GS.  Ceftriaxone: a review of its antibacterial activity, pharmacological proprieties, and therapeutic use. Drugs . 1984;;27:469-527.
6 +
Baumgartner JD, Glauser MP.  Single daily dose treatment of severe refractory infections with ceftriaxone: cost savings and possible parenteral outpatient treatment. Arch Intern Med . 1984;; 143:1868-1873.
7 +
Russo TA, Cook S, Gorbach SL.  Intramuscular ceftriaxone in home parenteral therapy. Antimicrob Agents Chemother . 1988;;32:1439-1440.
8 +
Bradley JS, Ching DK, Philips SE.  Outpatient therapy of serious pediatric infections with ceftriaxone. Pediatr Infect Dis J . 1988;;7:160-164.
9 +
Von Reyn CF, Levy BS, Arbeit RD, et al.  Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med . 1981;;94:505-518.
10 +
Wolfe JC, Johnson WD Jr.  Penicillin-sensitive streptococcal endocarditis in vitro and clinical observations on penicillin-streptomycin therapy. Ann Intern Med . 1974;;81:178-181.
11 +
Karchmer AW, Moellering RC, Maki DG, Swartz MN.  Single-antibiotic therapy for streptococcal endocarditis. JAMA . 1979;;241:1801-1806.
12 +
Malacoff RF, Frank E, Andriole VT.  Streptococcal endocarditis (nonenterococcal, non-group A) single vs combination therapy. JAMA . 1979;; 241:1807-1810.
13 +
Stamboulian D, Bonvehi P, Arevalo C, et al.  Antiobiotic management of outpatients with endocarditis due to penicillin-susceptible streptococci. Rev Infect Dis . 1991;;13:( (suppl 2) )160-163.
14 +
Wilson WR, Thompson RL, Wilkowske CJ, et al.  Short-term therapy for streptococcal infective endocarditis: combined intramuscular administration of penicillin and streptomycin. JAMA . 1981;;245:360-363.
15 +
Olaison L, Alestig K.  A prospective study of neutropenia induced by high doses of betalactam antibiotics. J Antimicrob Chemother . 1990;;25:449-453.
16 +
Pfeifer JF, Lipton MJ, Oury JH, Angell WW, Hultgren HN.  Case reports: acute coronary embolism complicating bacterial endocarditis: operative treatment. Am J Cardiol . 1976;;37:920-922.
17 +
Greenberg BH, Hoffman P, Schiller NB, Miller M, Chatterjee K.  Sudden death in infective endocarditis. Chest . 1977;;71:794-795.
18 +
Pruitt AA, Rubin RH, Karchmer AW, Duncan GW.  Neurologic complications of bacterial endocarditis. Medicine . 1978;;57:329-343.
19 +
Salgado AV, Furlan AJ, Keys TF, Nichols TR, Beck GJ.  Neurologic complications of endocarditis: a 12-year experience. Neurology . 1989;;39:173-178.
20 +
Paschalis C, Pugsley W, John E, Harrison MJG.  Rate of cerebral embolic events in relation to antibiotic and anticoagulant therapy in patients with bacterial endocarditis. Eur Neurol . 1990;; 30:87-89.
21 +
Jaffe WM, Morgan DE, Pearlman AS, Otto CM.  Infective endocarditis, 1983-1988: echocardiographic findings and factors influencing morbidity and mortality. J Am Coll Cardiol . 1990;;15:1227-1233.
22 +
Mugge A, Daniel WG, Frank G, Lichtlen PR.  Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size detemined by the transthoracic and the transesophageal approach. J Am Coll Cardiol . 1989;; 14:631-638.
23 +
Dajani AS, Bisno AL, Chung KJ, et al.  Prevention of bacterial endocarditis: recommendations by the American Heart Association. JAMA . 1990;; 264:2919-2922.

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