Ceftriaxone once daily for four weeks compared with ceftriaxone plus gentamicin once daily for two weeks for treatment of endocarditis due to penicillin-susceptible streptococci

This randomized, multicenter, open-label study compared the efficacy and sa fety of monotherapy with 2 g of intravenous ceftriaxone once daily for 4 we eks with those of combination therapy with 2 g of intravenous ceftriaxone a nd 3 mg of intravenous gentamicin/kg once daily for 2 weeks as therapy for endocarditis due to penicillin-susceptible streptococci. Sixty-one patients were enrolled in the study. Clinical cure was observed for 51 evaluable pa tients both at termination of therapy and at the 3-month follow-up: 25 (96. 2%) of 26 monotherapy recipients and 24 (96%) of 25 combination therapy rec ipients. Of the 23 patients in each treatment group who were microbiologica lly evaluable, 22 (95.7%) in each group were considered cured. No patient h ad evidence of relapse. Fourteen patients (27.5%) required cardiac surgery after initiation of treatment, including five monotherapy recipients and ni ne combination therapy recipients. Adverse effects were minimal in both tre atment groups. We conclude that 2 g of ceftriaxone once daily for 4 weeks a nd 2 g of ceftriaxone in combination with 3 mg of gentamicin/kg once daily for 2 weeks are both effective and safe for the treatment of streptococcal endocarditis.