A Review of Combination Antimicrobial Therapy for Enterococcus faecalis Bloodstream Infections and Infective Endocarditis

Clin Infect Dis. 2018 Jul 2;67(2):303-309. doi: 10.1093/cid/ciy064.


Enterococci, one of the most common causes of hospital-associated infections, are responsible for substantial morbidity and mortality. Enterococcus faecalis, the more common and virulent species, causes serious high-inoculum infections, namely infective endocarditis, that are associated with cardiac surgery and mortality rates that remained unchanged for the last 30 years. The best cures for these infections are observed with combination antibiotic therapy; however, optimal treatment has not been fully elucidated. It is the purpose of this review to highlight treatment options and their limitations, and provide direction for future investigative efforts to aid in the treatment of these severe infections. While ampicillin plus ceftriaxone has emerged as a preferred treatment option, mortality rates continue to be high, and from a safety standpoint, ceftriaxone, unlike other cephalosporins, promotes colonization with vancomycin resistant-enterococci due to high biliary concentrations. More research is needed to improve patient outcomes from this high-mortality disease.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Ampicillin / therapeutic use
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteremia / drug therapy*
  • Ceftriaxone / therapeutic use
  • Cephalosporins / therapeutic use
  • Clinical Trials as Topic
  • Drug Synergism
  • Drug Therapy, Combination
  • Endocarditis, Bacterial / drug therapy*
  • Enterococcus faecalis / drug effects*
  • Gram-Positive Bacterial Infections / complications
  • Gram-Positive Bacterial Infections / drug therapy*
  • Humans
  • Microbial Sensitivity Tests
  • Vancomycin-Resistant Enterococci / drug effects


  • Anti-Bacterial Agents
  • Cephalosporins
  • Ceftriaxone
  • Ampicillin