Lincoln L J, Weinstein A J, Gallagher M, Abrutyn E
Antimicrob Agents Chemother. 1977 Oct;12(4):484-9. doi: 10.1128/AAC.12.4.484.
Previous in vitro studies demonstrating that the penicillinase-resistant penicillins act synergistically in combination with gentamicin against some enterococci have suggested that these combinations might be effective therapy for enterococcal infections in vivo. To determine the in vivo effectiveness of such combinations, we treated rabbits with enterococcal endocarditis with gentamicin and either nafcillin, oxacillin, or methicillin. Despite doses of the penicillins equivalent to 12 or 24 g/day in a 70-kg patient, the percentage of animals in each treatment group with sterile valves at autopsy after spontaneous death or sacrifice after 21 days of therapy was low. High-dose therapy with the penicillins did not significantly increase survival over the low-dose treatment groups. Thus, it seems prudent to include penicillin with a penicillinase-resistant penicillin and gentamicin as the initial therapy of patients with endocarditis possibly caused by enterococci.
先前的体外研究表明，耐青霉素酶的青霉素与庆大霉素联合使用时，对某些肠球菌具有协同作用，这表明这些联合用药可能是治疗肠球菌感染的有效体内疗法。为了确定这种联合用药的体内有效性，我们用庆大霉素和萘夫西林、苯唑西林或甲氧西林治疗患有肠球菌性心内膜炎的兔子。尽管所用青霉素剂量相当于一名70公斤患者每天12或24克，但在治疗21天后自然死亡或处死后进行尸检时，每个治疗组中瓣膜无菌的动物百分比都很低。与低剂量治疗组相比，高剂量青霉素治疗并没有显著提高生存率。因此，对于可能由肠球菌引起的心内膜炎患者，将青霉素与耐青霉素酶的青霉素及庆大霉素联合作为初始治疗似乎是谨慎的做法。
