阿莫西林联合口服头孢菌素对心内膜炎相关粪肠球菌临床分离株的体外活性
In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates.
摘要(中文译文)
氨苄西林联合肠外头孢菌素对粪肠球菌具有协同活性。口服巩固治疗是粪肠球菌感染性心内膜炎（EFIE）的一种选择，但最佳口服方案仍存在争议。我们旨在评估基于阿莫西林联合口服头孢菌素（即头孢氨苄或头孢克肟）的组合对粪肠球菌菌株的体外活性。针对6株与心内膜炎相关的粪肠球菌临床分离株测定了MIC和MBC值。采用阿莫西林（½MIC）联合不同浓度（Cmax、½Cmax和Cmin）的头孢氨苄或头孢克肟进行时间-杀菌（TK）实验。对照方案为阿莫西林/头孢唑林和阿莫西林/头孢曲松。TK实验在标准接种量（约5×10⁵ cfu/mL）和高接种量（约10⁸ cfu/mL）下进行。在标准接种量下，阿莫西林联合口服头孢菌素Cmax、½Cmax或Cmin时，联合头孢氨苄在66%、33%和0%的粪肠球菌分离株中观察到协同或相加作用；联合头孢克肟分别在83%、50%和33%的分离株中观察到协同或相加作用。在对照方案中，标准接种量下所有分离株均发现协同作用。在高接种量下，阿莫西林/头孢克肟在Cmax时与阿莫西林/头孢曲松疗效相似，在50%的粪肠球菌分离株中显示协同作用，而阿莫西林/头孢氨苄在Cmax时和阿莫西林/头孢唑林仅在17%的分离株中实现协同作用。阿莫西林/头孢克肟组合在标准接种量下对大多数粪肠球菌菌株表现出协同作用。头孢克肟可能作为阿莫西林的一种有前景的辅助治疗药物，用于EFIE的口服巩固治疗。
Abstract
Aminopenicillin associated with parenteral cephalosporins provides synergistic activity against Enterococcus faecalis. Oral consolidation treatment is an option for infective endocarditis E. faecalis (EFIE), but optimal oral regimen remains under debate. We aimed to assess the in vitro activity of combinations based on amoxicillin plus an oral cephalosporin, namely, cephalexin or cefixime, against E. faecalis strains. MIC and MBC values were determined against 6 clinical isolates of endocarditis-associated E. faecalis. Time-kill (TK) experiments were performed using amoxicillin (½MIC) plus cephalexin or cefixime at different concentrations (Cmax, ½Cmax and Cmin). Comparator regimens were amoxicillin/cefazolin and amoxicillin/ceftriaxone. TK experiments were carried out at standard (∼5 × 105 cfu/mL) and high inoculum (∼108 cfu/mL). Using amoxicillin combined with Cmax, ½Cmax or Cmin of oral cephalosporin at standard inoculum, synergy or additivity was observed in 66, 33 and 0% of E. faecalis isolates with adjunctive cephalexin; and in 83, 50 and 33% of isolates with adjunctive cefixime, respectively. In comparator regimens, synergy was found in all isolates at standard inoculum. At high inoculum, amoxicillin/cefixime at Cmax had similar efficacy to amoxicillin/ceftriaxone, showing synergy in 50% of E. faecalis isolates, while amoxicillin/cephalexin at Cmax and amoxicillin/cefazolin only achieved synergy in 17% of isolates. The combination of amoxicillin/cefixime exhibits synergy in most E. faecalis strains at standard inoculum. Cefixime could represent an interesting adjunctive therapy to amoxicillin for oral consolidation treatment of EFIE.
如何引用
AMA
David Luque Paz, María Alexandra Cañas, Guillermo Cuervo, Mateu Espasa, Marta Hernandez-Meneses, Eduard Quintana, et al. In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates.. The Journal of antimicrobial chemotherapy. 2026; doi:10.1093/jac/dkag127.
APA
David Luque Paz, María Alexandra Cañas, Guillermo Cuervo, Mateu Espasa, Marta Hernandez-Meneses, Eduard Quintana, et al (2026). In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates.. The Journal of antimicrobial chemotherapy. https://doi.org/10.1093/jac/dkag127
GB/T 7714
David Luque Paz, María Alexandra Cañas, Guillermo Cuervo, Mateu Espasa, Marta Hernandez-Meneses, Eduard Quintana, et al. In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates.[J]. The Journal of antimicrobial chemotherapy, 2026 doi:10.1093/jac/dkag127.
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