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: firstname.lastname@example.org; email@example.com.
Alison Muir’s former affiliation is Heart of England NHS Foundation Trust.
The authors have no funding or conflicts of interest to disclose.