CASE REPORT article
Front. Cardiovasc. Med.
Sec. Cardiovascular Pharmacology and Drug Discovery
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1539372
Treatment of Infective Endocarditis caused by Enterococcus faecalis with a Combination of Penicillin G and Ceftriaxone: A Case Report and Literature Review
Provisionally accepted
- 1Fujian Medical University, Fuzhou, China
- 2Quanzhou First Hospital, Fujian Medical University, Quanzhou, Fujian Province, China
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This report presents a case of Infective Endocarditis (IE) caused by Enterococcus faecalis (E. faecalis). The E. faecalis isolates were sensitive to ampicillin, penicillin G, and vancomycin. However, the outcome of anti-infection therapy was poor, and the patient was suspected to be allergic to vancomycin and ampicillin-sulbactam. This prompted various changes in antibiotic treatment regimens, with the patient eventually cured after administration of penicillin G combined with ceftriaxone (PC regimen).Literature was retrieved from the CNKI, Wanfang, Weipu, and PubMed databases to determine the efficacy of the PC regimen in the treatment of E. faecalis-induced IE.From the literature retrieved and our case study, there were only five reports of cases that had been treated with the PC regimen, with a mean age of (61.6±17.2) years.The cases that had been previously reported in the literature involved patients of advanced age with complicated underlying diseases such as chronic obstructive pulmonary disease (COPD), atrial valve replacement, bladder carcinoma, and type 2 diabetes mellitus. The minimal inhibitory concentration (MIC) of ampicillin against the E. faecalis isolates from all five patients was <2 μg/mL, and all isolates showed susceptibility to penicillin G. All five patients were initially treated with other antimicrobial regimens but were eventually cured after switching to the PC regimen.In conclusion, ampicillin combined with ceftriaxone (AC regimen) can be substituted with the PC regimen for the treatment of IE caused by penicillin-susceptible E.faecalis when ampicillin is not available, when outpatient parenteral antimicrobial therapy (OPAT) with an AC regimen is not feasible, or when the patient is allergic to ampicillin.
Keywords: Infective endocarditis, Enterococcus faecalis, Ampicillin, penicillin, Ceftriaxone (ceftriaxone)
Received: 04 Dec 2024; Accepted: 10 Jul 2025.
Copyright: © 2025 Jiang, Lin, Wu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhiqiang Lin, Quanzhou First Hospital, Fujian Medical University, Quanzhou, 362000, Fujian Province, China
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