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High-Level Aminoglycoside-Resistant Enterococcal Endocarditis: A Therapeutic Challenge

Muir, Alison MB, BChir, MA, PhD, DTM&H*; Pillay, Das G. MBChB, FCPath; Hill, Robert L.R. PhD, Med, MIBiol

Infectious Diseases in Clinical Practice: January 2013 - Volume 21 - Issue 1 - p 3–5
doi: 10.1097/IPC.0b013e31825aee03
Review Articles

Abstract: Enterococci with high-level resistance to multiple aminoglycosides account for approximately one quarter of enterococcal endocarditis cases, yet there is a lack of consensus concerning optimal therapy. This issue is particularly topical as new British guidelines for the treatment of endocarditis have recently been published. We present a case of endocarditis caused by enterococci with high-level aminoglycoside resistance that was successfully treated with the counter-intuitive combination of amoxicillin and ceftriaxone. The rationale and evidence for this decision is reviewed, and other possible treatments are discussed.

From the *University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston; †Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham; and ‡Microbiological Services Division, Health Protection Agency, Colindale, London, UK.

Correspondence to: Alison Muir, MB, BChir, MA, PhD, DTM&H, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB. E-mail:;

Alison Muir’s former affiliation is Heart of England NHS Foundation Trust.

The authors have no funding or conflicts of interest to disclose.

© 2013 Lippincott Williams & Wilkins, Inc.