In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates
Objectives: Aminopenicillin associated with parenteral cephalosporins provides synergistic activity against Enterococcus faecalis. Oral consolidation treatment is an option for infective endocarditis E. faecalis (EFIE), but optimal oral regimen remains under debate. We aimed to assess the in vitro a...
| Autores: | , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión aceptada para publicación |
| Fecha de publicación: | 2026 |
| País: | España |
| Institución: | Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| Repositorio: | Recercat. Dipósit de la Recerca de Catalunya |
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| Acceso en línea: | https://hdl.handle.net/2445/229583 |
| Access Level: | acceso embargado |
| Palabra clave: | Endocarditis Amoxicil·lina Malalties bacterianes Amoxicillin Bacterial diseases |
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In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolatesLuque Paz, DavidCañas, María AlexandraCuervo Requena, GuillermoEspasa, MateuHernández Meneses, MartaQuintana, EduardFalces Salvador, CarlesTolosana, José M. (José María)Vidal, BàrbaraPerissinotti, AndrésLlopis Pérez, JaimeMoreno Camacho, Ma. AsunciónGarcía de la Mària, CristinaMiró Meda, José M. (José María), 1956-EndocarditisAmoxicil·linaMalalties bacterianesEndocarditisAmoxicillinBacterial diseasesObjectives: Aminopenicillin associated with parenteral cephalosporins provides synergistic activity against Enterococcus faecalis. Oral consolidation treatment is an option for infective endocarditis E. faecalis (EFIE), but optimal oral regimen remains under debate. We aimed to assess the in vitro activity of combinations based on amoxicillin plus an oral cephalosporin, namely, cephalexin or cefixime, against E. faecalis strains. Methods: MIC and MBC values were determined against 6 clinical isolates of endocarditis-associated E. faecalis. Time-kill (TK) experiments were performed using amoxicillin (½MIC) plus cephalexin or cefixime at different concentrations (Cmax, ½Cmax and Cmin). Comparator regimens were amoxicillin/cefazolin and amoxicillin/ceftriaxone. TK experiments were carried out at standard (∼5 × 105 cfu/mL) and high inoculum (∼108 cfu/mL). Results: Using amoxicillin combined with Cmax, ½Cmax or Cmin of oral cephalosporin at standard inoculum, synergy or additivity was observed in 66, 33 and 0% of E. faecalis isolates with adjunctive cephalexin; and in 83, 50 and 33% of isolates with adjunctive cefixime, respectively. In comparator regimens, synergy was found in all isolates at standard inoculum. At high inoculum, amoxicillin/cefixime at Cmax had similar efficacy to amoxicillin/ceftriaxone, showing synergy in 50% of E. faecalis isolates, while amoxicillin/cephalexin at Cmax and amoxicillin/cefazolin only achieved synergy in 17% of isolates. Conclusions: The combination of amoxicillin/cefixime exhibits synergy in most E. faecalis strains at standard inoculum. Cefixime could represent an interesting adjunctive therapy to amoxicillin for oral consolidation treatment of EFIE.Oxford University Press202620262026infoinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersion18 p.application/pdfhttps://hdl.handle.net/2445/229583Articles publicats en revistes (Medicina)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésVersió postprint del document publicat a: https://doi.org/10.1093/jac/dkag127Journal of Antimicrobial Chemotherapy, 2026, vol. 81, num.5https://doi.org/10.1093/jac/dkag127(c) Luque Paz, D. et al., 2026info:eu-repo/semantics/embargoedAccessoai:dnet:recercat____::7a5e0b1162eb7fb35aa4176bbe1fa2b22026-05-29T05:05:01Z |
| dc.title.none.fl_str_mv |
In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates |
| title |
In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates |
| spellingShingle |
In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates Luque Paz, David Endocarditis Amoxicil·lina Malalties bacterianes Endocarditis Amoxicillin Bacterial diseases |
| title_short |
In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates |
| title_full |
In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates |
| title_fullStr |
In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates |
| title_full_unstemmed |
In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates |
| title_sort |
In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates |
| dc.creator.none.fl_str_mv |
Luque Paz, David Cañas, María Alexandra Cuervo Requena, Guillermo Espasa, Mateu Hernández Meneses, Marta Quintana, Eduard Falces Salvador, Carles Tolosana, José M. (José María) Vidal, Bàrbara Perissinotti, Andrés Llopis Pérez, Jaime Moreno Camacho, Ma. Asunción García de la Mària, Cristina Miró Meda, José M. (José María), 1956- |
| author |
Luque Paz, David |
| author_facet |
Luque Paz, David Cañas, María Alexandra Cuervo Requena, Guillermo Espasa, Mateu Hernández Meneses, Marta Quintana, Eduard Falces Salvador, Carles Tolosana, José M. (José María) Vidal, Bàrbara Perissinotti, Andrés Llopis Pérez, Jaime Moreno Camacho, Ma. Asunción García de la Mària, Cristina Miró Meda, José M. (José María), 1956- |
| author_role |
author |
| author2 |
Cañas, María Alexandra Cuervo Requena, Guillermo Espasa, Mateu Hernández Meneses, Marta Quintana, Eduard Falces Salvador, Carles Tolosana, José M. (José María) Vidal, Bàrbara Perissinotti, Andrés Llopis Pérez, Jaime Moreno Camacho, Ma. Asunción García de la Mària, Cristina Miró Meda, José M. (José María), 1956- |
| author2_role |
author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
Endocarditis Amoxicil·lina Malalties bacterianes Endocarditis Amoxicillin Bacterial diseases |
| topic |
Endocarditis Amoxicil·lina Malalties bacterianes Endocarditis Amoxicillin Bacterial diseases |
| description |
Objectives: Aminopenicillin associated with parenteral cephalosporins provides synergistic activity against Enterococcus faecalis. Oral consolidation treatment is an option for infective endocarditis E. faecalis (EFIE), but optimal oral regimen remains under debate. We aimed to assess the in vitro activity of combinations based on amoxicillin plus an oral cephalosporin, namely, cephalexin or cefixime, against E. faecalis strains. Methods: MIC and MBC values were determined against 6 clinical isolates of endocarditis-associated E. faecalis. Time-kill (TK) experiments were performed using amoxicillin (½MIC) plus cephalexin or cefixime at different concentrations (Cmax, ½Cmax and Cmin). Comparator regimens were amoxicillin/cefazolin and amoxicillin/ceftriaxone. TK experiments were carried out at standard (∼5 × 105 cfu/mL) and high inoculum (∼108 cfu/mL). Results: Using amoxicillin combined with Cmax, ½Cmax or Cmin of oral cephalosporin at standard inoculum, synergy or additivity was observed in 66, 33 and 0% of E. faecalis isolates with adjunctive cephalexin; and in 83, 50 and 33% of isolates with adjunctive cefixime, respectively. In comparator regimens, synergy was found in all isolates at standard inoculum. At high inoculum, amoxicillin/cefixime at Cmax had similar efficacy to amoxicillin/ceftriaxone, showing synergy in 50% of E. faecalis isolates, while amoxicillin/cephalexin at Cmax and amoxicillin/cefazolin only achieved synergy in 17% of isolates. Conclusions: The combination of amoxicillin/cefixime exhibits synergy in most E. faecalis strains at standard inoculum. Cefixime could represent an interesting adjunctive therapy to amoxicillin for oral consolidation treatment of EFIE. |
| publishDate |
2026 |
| dc.date.none.fl_str_mv |
2026 2026 2026 info |
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info:eu-repo/semantics/article info:eu-repo/semantics/acceptedVersion |
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article |
| status_str |
acceptedVersion |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/2445/229583 |
| url |
https://hdl.handle.net/2445/229583 |
| dc.language.none.fl_str_mv |
Inglés |
| language_invalid_str_mv |
Inglés |
| dc.relation.none.fl_str_mv |
Versió postprint del document publicat a: https://doi.org/10.1093/jac/dkag127 Journal of Antimicrobial Chemotherapy, 2026, vol. 81, num.5 https://doi.org/10.1093/jac/dkag127 |
| dc.rights.none.fl_str_mv |
(c) Luque Paz, D. et al., 2026 info:eu-repo/semantics/embargoedAccess |
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(c) Luque Paz, D. et al., 2026 |
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embargoedAccess |
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18 p. application/pdf |
| dc.publisher.none.fl_str_mv |
Oxford University Press |
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Oxford University Press |
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Articles publicats en revistes (Medicina) reponame:Recercat. Dipósit de la Recerca de Catalunya instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
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Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
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Recercat. Dipósit de la Recerca de Catalunya |
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Recercat. Dipósit de la Recerca de Catalunya |
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