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Chapter 16 : Treatment of Experimental and Human Bacterial Endocarditis with Quinolone Antimicrobial Agents

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Abstract:

Effective antimicrobial agents must sterilize vegetations containing high bacterial densities in the presence of an indwelling foreign body. This chapter concentrates predominantly on a detailed analysis of the results of quinolone treatment protocols in discriminative animal models of bacterial endocarditis (BE) that may be relevant to the treatment of human BE. In addition, the available literature on the efficacy of quinolones in human BE is summarized. This therapeutic difference occurred despite the β-lactam agents being present within infected vegetations at concentrations above the minimal bactericidal concentrations (MBCs) for periods similar to those observed in the ciprofloxacin-treated animals. This study confirmed the importance of pharmacodynamic parameters such as postantibiotic effect and time-above-MBC at the tissue infection site as dual determinants of the outcome of β-lactam therapy in experimental BE. The Dworkin and coworkers study was an open, nonrandomized evaluation, and the excellent results prompted a larger, prospective, randomized trial comparing oral ciprofloxacin plus rifampin versus nafcillin plus gentamicin in addict-related, right-sided BE. The newer quinolones (e.g., levofloxacin and trovafloxacin) also appear to be highly active in vivo against both methicillin-susceptible (MSSA) and methicillin-resistant (MRSA) strains in experimental BE models.

Citation: Le T, Yeaman M, Bayer A. 2003. Treatment of Experimental and Human Bacterial Endocarditis with Quinolone Antimicrobial Agents, p 259-273. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch16
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References

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Tables

Generic image for table
Table 1

Summary of in vivo activity of fluoroquinolones in animal endocarditis models

Citation: Le T, Yeaman M, Bayer A. 2003. Treatment of Experimental and Human Bacterial Endocarditis with Quinolone Antimicrobial Agents, p 259-273. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch16
Generic image for table
Table 2

Summary of activity of fluoroquinolones in human bacterial endocarditis

Citation: Le T, Yeaman M, Bayer A. 2003. Treatment of Experimental and Human Bacterial Endocarditis with Quinolone Antimicrobial Agents, p 259-273. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch16

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