Gentamicin once-daily in enterococcal endocarditis

摘要

Enterococcal endocarditis represents the third cause of infectious endocarditis (IE) following staphylococcal and streptococcal species and reaching up to 20% of all cases.Recently revised guidelines recommend the use of beta-lactams in association with gentamicin administered twice or three times daily for IE due to enterococcal strains that are documented to be susceptible to these compounds. Enterococci are relatively impermeable to aminoglycosides. Cell wall-active agents (i.e., beta-lactams or glycopeptides) increase the permeability of the enterococcal membrane, and hence a bactericidal effect can be achieved by diffusion of the aminoglycoside at adequate concentrations without excessive toxicity. Thus, high concentration of aminoglycosides in the extracellular milieu during co-treatment with cell wall-active agents might allow increased drug level at the site of the ribosomal target within the bacterial cell for bactericidal activity.