Treatment of Infective Endocarditis Due to HLAR (High-Level Aminoglycoside Resistant) Enterococcus

When infective endocarditis is caused by Enterococcus spp. with high-level aminoglycoside resistance (HLAR), standard aminoglycoside-based synergy cannot be used, requiring a distinct and specific combination strategy for both native and prosthetic valve disease.

Clinical scenario

Infective endocarditis due to HLAR Enterococcus spp. — native valve endocarditis (NVE) or prosthetic valve endocarditis (PVE) in which the causative Enterococcus isolate demonstrates high-level resistance to aminoglycosides, ruling out aminoglycoside-containing regimens.

Treatment approach

The recommended strategy centres on a specific dual-agent antibiotic combination — involving ampicillin or amoxicillin alongside another agent — administered over an extended intravenous course.

Full regimen, dosing, and duration are detailed in the complete protocol →

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References

DOI: 10.1093/eurheartj/ehad193

In patients with NVE or PVE due to HLAR Enterococcus spp., the combination of ampicillin or amoxicillin and ceftriaxone for 6 weeks is recommended using the following doses:

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