ENTEROCOCCAL ENDOCARDITIS - A CASE TREATED WITH TEICOPLANIN AND AMOXICILLIN

The study aimed to determine the antibacterial therapy effective in th e cure of endocarditis caused by Enterococcus faecalis resistant to cl inically achievable levels of vancomycin. Isolation of the causative e nterococcus had been achieved by direct inoculation of the resected va lve into the culture medium in theatre, The patient was known to have had an aortic valve defect since childhood and had recently undergone splenectomy following trauma. Blood cultures were negative prior to va lve replacement. A perivalvular abscess was noted at operation. In vit ro minimal bactericidal results and serum activity were the basis of t he postoperative choice of drugs. The minimal bactericidal level of te icoplanin was 250 mu g/ml and that of amoxycillin 64 mu g/ml. Neither is achievable with the advocated dosage. A combination of these two ce ll-wall-active agents successfully eliminated the infection. Acting at two different sites in the synthesis of the bacterial cell wall, teic oplanin and amoxycillin were found to be bactericidal in vitro at the trough levels of the antibiotics in the serum. The patient recovered f ully.