High-dose trimethoprim-sulfamethoxazole and clindamycin for Staphylococcus aureus endocarditis.

Abstract

OBJECTIVE:

The mortality rate for Staphylococcus aureus endocarditis remains as high as 20-30% despite improvements in medical and surgical treatment. This study evaluated the efficiency and tolerance of a combination of intravenous trimethoprim-sulfamethoxazole and clindamycin (T&C) +/- rifampicin and gentamicin, with a rapid switch to oral administration of T&C.

METHODS:

This before-after intervention study compared the outcomes of 170 control patients before introduction of the T&C protocol (2001-2011) with the outcomes of 171 patients in the T&C group (2012-2016). All patients diagnosed with S. aureus infective endocarditis and referred to the study centre between 2001 and 2016 were included. Between 2001 and 2011, the patients received a standardized antibiotic treatment: oxacillin or vancomycin for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol has included a high dose of T&C (intravenous, switched to oral administration on day 7). Rifampicin and gentamicin are also given in cases of cardiac abscess or persistent bacteraemia.

RESULTS:

The two groups were slightly different. On intention-to-treat analysis, global mortality (19% vs 30%, P=0.024), in-hospital mortality (10% vs 18%, P=0.03) and 30-day mortality (7% vs 14%, P=0.05) were lower in the T&C group. The mean duration of hospital stay was significantly shorter in the T&C group (30 vs 39 days; P=0.005).

CONCLUSIONS:

The management of S. aureus infective endocarditis using a rapid shift to oral administration of T&C reduced the length of hospital stay and the mortality rate.

• Authors: Hervé Tissot-Dupont, Frédérique Gouriet, Leopold Oliver, Matthieu Jamme, Jean-Paul Casalta, Marie-Thérèse Jimeno, Florent Arregle, Cécile Lavoute, Sandrine Hubert, Mary Philip, Hélène Martel, Alberto Riberi, Gilbert Habib, Didier Raoult
• Journal: International journal of antimicrobial agents (Int J Antimicrob Agents) Vol. 54 Issue 2 Pg. 143-148 (Aug 2019) ISSN: 1872-7913 [Electronic] Netherlands
• PMID: 31181351 (Publication Type: Journal Article)
• Copyright: Copyright © 2019. Published by Elsevier B.V.

Chemical References

• Anti-Bacterial Agents
• Gentamicins
• Clindamycin
• Trimethoprim, Sulfamethoxazole Drug Combination
• Rifampin

Topics

• Administration, Intravenous
• Administration, Oral
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (administration & dosage, adverse effects)
• Clindamycin (administration & dosage, adverse effects)
• Drug Therapy, Combination (methods)
• Endocarditis, Bacterial (drug therapy)
• Female
• Gentamicins (administration & dosage, adverse effects)
• Humans
• Male
• Middle Aged
• Prospective Studies
• Rifampin (administration & dosage, adverse effects)
• Staphylococcal Infections (drug therapy)
• Treatment Outcome
• Trimethoprim, Sulfamethoxazole Drug Combination (administration & dosage, adverse effects)
• Young Adult