Ampicillin/ceftriaxone vs. β-lactam/aminoglycoside combination therapy for Enterococcus faecalis infective endocarditis: a systematic review and meta-analysis

Enterococcus faecalis infective endocarditis (EFIE) remains a formidable infection requiring prolonged antimicrobial therapy. Although β-lactam/aminoglycoside (BL + AG) combination therapy has long been regarded as the standard treatment, AG-associated toxicities pose a major clinical dilemma. Recently, dual β-lactam therapy with ampicillin/ceftriaxone (A + C) has become an established treatment option....

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✦ The floor

Discussion

Signed responses from readers of the wire.

✦ Clinical Takeaway ✦

Audiologists working in hospital or oncology settings should be aware of this meta-analysis: if ampicillin/ceftriaxone is shown to be equally or more effective than aminoglycoside-based regimens, it supports a shift away from ototoxic antibiotics — potentially reducing referrals for aminoglycoside-induced hearing loss monitoring.

✦ Why It Matters ✦

Aminoglycosides are a leading cause of drug-related hearing damage (ototoxicity); evidence favouring aminoglycoside-sparing regimens for endocarditis has direct implications for ototoxicity prevention and audiological monitoring programmes.

✦ Key Points ✦

01Systematic review and meta-analysis published in European Journal of Clinical Microbiology & Infectious Diseases.
02Compares ampicillin/ceftriaxone vs. beta-lactam/aminoglycoside for Enterococcus faecalis endocarditis.
03Aminoglycosides carry known risk of ototoxicity (hearing damage caused by medication).
04If ampicillin/ceftriaxone proves non-inferior, it supports reducing aminoglycoside use and associated hearing risk.
05Full results and effect sizes are not available from the title/abstract alone.

✦ Claims & Evidence ✦

ClaimEvidenceSupport

Ampicillin/ceftriaxone is compared to beta-lactam/aminoglycoside combination therapy as a treatment for Enterococcus faecalis infective endocarditis.

studysupported

Aminoglycoside-containing regimens carry ototoxicity risk relevant to audiology practice.

guidelinesupported

✦ Research metadata ✦

PMID: 42581256
DOI: 10.1007/s10096-026-05625-y.
Journal: European Journal of Clinical Microbiology & Infectious Diseases
Publication type: meta_analysis
Evidence level: 1a
Population: Patients with Enterococcus faecalis infective endocarditis
Intervention: Ampicillin/ceftriaxone combination therapy
Comparator: Beta-lactam/aminoglycoside combination therapy

Primary outcomes

Clinical efficacy (treatment success or mortality); Safety profile including ototoxicity risk

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