Penicillin/gentamicin vs ampicillin/sulbactam/gentamicin vs vancomycin/gentamicin in the empirical therapy of native valve infective endocarditis

Abstract

AIM: The aim of this studt to compare the therapy responses of native valve IE patients in whom empirical penicillin +gentamicin, ampicillin/sulbactam + gentamicin, or vancomycin + gentamicin were initiated. BACKGROUND: Despite developments in antibiotics and medicine,infective endocarditis (IE) is associated with significant morbidity and mortality METHODS: Outcomes of patients in whom empirical penicillin + gentamicin (PENG),ampicillin/sulbactam + gentamicin (SAMG), or vancomycin + gentamicin (VANG) were initiated for native valve IE (according tomodified Duke criteria) between March 2007 and November 2023 were evaluated retrospectively. Of note, antistaphylococcal penicillins have never been available in our setting/country. Patients were analyzed in terms of demographic features, clinical and laboratory findings, therapy responses and mortality. Patients were given ampicillin/sulbactam 12 gr + gentamicin 3 mg/kg/daily, penicillin 24 MU+ gentamicin 3 mg/kg/daily, and vancomycin 2 gr/daily + gentamicin 3 mg/kg/daily. We used Chi-square,Fisher Exact and One Way Anova tests for statistical comparison. RESULTS: There were 38, 40 and 11 patients in PENG, SAMG and VANG cohorts,respectively. While S. viridans were significantly more common in PENG cohort, there was no significant difference between the three cohorts in terms of age, gender, fever, presence of vegetation, IE with microbiological evidence, culture-negative IE, S.aureus and Enterococcus spp. successful outcome without antimicrobial modification and end of treatment mortality (Table 1). Conculisons: Despite the relatively low number of cases in both arms, there was no significant difference between the three therapy cohorts in our series. The possible reason may be the relatively few S.aureus in the etiology.

Keywords

• Infective Endocarditis
• Empirical Treatment
• Native Valve Endocarditis