RESUMEN
Aminoglycosides are useful antimicrobial agents for treating infective endocarditis; however, they occasionally cause troublesome side effects, such as nephrotoxicity and ototoxicity. We herein report a case of infective endocarditis caused by Enterococcus faecalis that was treated successfully with continuous infusion of ampicillin without adjunctive aminoglycosides. The serum ampicillin concentrations were higher than the minimal inhibitory concentration for the target strain. Although the use of ampicillin monotherapy is currently avoided because double ß-lactam therapy is reportedly more effective, continuous penicillin administration remains an effective therapeutic choice for treating infective endocarditis.
Asunto(s)
Ampicilina/uso terapéutico , Antibacterianos/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Enterococcus faecalis/aislamiento & purificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Anciano , Aminoglicósidos/efectos adversos , Ampicilina/administración & dosificación , Ampicilina/sangre , Ampicilina/farmacología , Antibacterianos/administración & dosificación , Antibacterianos/sangre , Antibacterianos/farmacología , Anticoagulantes/uso terapéutico , Artroplastia de Reemplazo de Cadera , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Contraindicaciones , Diagnóstico Diferencial , Endocarditis Bacteriana/sangre , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Enterococcus faecalis/efectos de los fármacos , Fracturas del Cuello Femoral/cirugía , Infecciones por Bacterias Grampositivas/sangre , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Infusiones Intravenosas , Masculino , Pruebas de Sensibilidad Microbiana , Válvula Mitral/microbiología , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Guías de Práctica Clínica como Asunto , Pielonefritis/diagnóstico , Estreptomicina , Warfarina/uso terapéuticoRESUMEN
Longterm macrolide therapy (LTMT) has been employed as an effective therapy both for diffuse panbronchiolitis in Japan and for cystic fibrosis in European countries. However, effects on antibiotic susceptibility profiles of microorganisms, associated with such long-term administration of antibiotics, are of concern. We retrospectively identified 57 pneumococcal isolates, recovered from the same number of patients receiving either LTMT with 400 mg of clarithromycin daily (CAM group; n = 31) or 600 mg of erythromycin daily (EM group; n = 26) by reviewing the patients' records at Nara Medical University. On analysis, we found that all isolates recovered from the CAM group and 25 of the 26 recovered from the EM group were resistant to EM, showing either an MLSB: or an M phenotype. Interestingly, isolates exhibiting the M phenotype were much less frequent in the CAM group (2 of 31; 6.5%) than in the EM group (15 of 26; 57.7%). No increase in the rate of penicillin resistance was observed in either group. The macrolide resistance profiles of microorganisms may be influenced differently according to differences in the kind of macrolide antibiotics used.