Enterococcus faecalis infective endocarditis

Infection of the inner lining of the heart and its valves caused by the bacterium Enterococcus faecalis, often originating from the gut or urinary tract. The strains involved have no high-level aminoglycoside resistance (non-HLAR), so a synergistic antibiotic combination remains effective.

ICD-10 I331 drug

Also known as: Enterococcal infective endocarditis, Enterococcus faecalis endocarditis (non-HLAR), Enterococcal endocarditis

Drugs used for this condition

AGentamicinFirst line · Aminoglycoside antibioticIn endocarditis caused by Enterococcus faecalis without high-level aminoglycoside resistance (non-HLAR), gentamicin is first-line: ampicillin plus gentamicin carries a Class I recommendation in the ESC 2023 and AHA/IDSA 2015 guidelines, on par with ampicillin plus ceftriaxone. Gentamicin is given at 3 mg/kg/day in 2–3 divided doses for a synergistic bactericidal effect with the beta-lactam, since beta-lactam therapy alone is only bacteriostatic against enterococci. Ampicillin plus ceftriaxone is an equivalent alternative when there is a risk of nephrotoxicity (Fernandez-Hidalgo, 2013), and this does not lower gentamicin's first-line status for non-HLAR strains. In staphylococcal endocarditis gentamicin plays a different role and is not first-line, so this entry should not be merged with broad gram-positive endocarditis.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit