Monotherapy could replace combination therapy in endocarditis

Researchers from the Respiratory Infections and Immunocompromised Host group at IDIBELL and the Bellvitge University Hospital have shown that monotherapy with a 3rd generation cephalosporin is effective and safe as a treatment for this serious infectious disease. These results will change international recommendations for its management.

Tractament antibiotic Endocarditis Estroptococcica_23_03

The multicenter study on the antibiotic treatment of streptococcal endocarditis, published in the Clinical Infectious Diseases journal, has included data from 914 patients and the participation of 40 hospital centers in Spain that are part of the prospective GAMES cohort (Grupo de Apoyo al Manejo de la Endocarditis en España), of the Spanish Society of Cardiovascular Infections (SEICAV). The research has been led by professionals from the Infectious Diseases Service of the Bellvitge University Hospital and the Bellvitge Biomedical Research Institute (IDIBELL).

Infective endocarditis is a heterogeneous and serious disease, with a major surgery rate of more than 50% and a mortality of 25%. Until now, international guidelines recommend the use of combination therapy with beta-lactams plus aminoglycosides in endocarditis caused by streptococci with intermediate sensitivity to penicillin. However, aminoglycosides are associated with the development of renal failure and other important adverse effects.

According to the results of the study led by the HUB and IDIBELL, monotherapy with a third-generation cephalosporin is an effective and safe alternative to combination treatment with aminoglycosides, presenting similar in-hospital mortality and relapse rates. The results of the study should be implemented in the next international guidelines for the management of infective endocarditis and change clinical practice.

As a highly complex hospital, the Bellvitge University Hospital treats some 80 endocarditis cases annually, offers support for their management to regional hospitals, and coordinates the Endocarditis Unit of the South Metropolitan health region. Identifying new strategies to improve the diagnosis and treatment of this serious infectious pathology is a priority research topic.



The Bellvitge Biomedical Research Institute (IDIBELL) is a biomedical research center created in 2004. It is participated by the Bellvitge University Hospital and the Viladecans Hospital of the Catalan Institute of Health, the Catalan Institute of Oncology, the University of Barcelona and the City Council of L’Hospitalet de Llobregat.

IDIBELL is a member of the Campus of International Excellence of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish research centers accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the “HR Excellence in Research” program of the European Union and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Center of the AECC Scientific Foundation (FCAECC).


Original paper:

Escrihuela-Vidal F, Berbel D, Fernández-Hidalgo N, et al. Impact of intermediate susceptibility to penicillin on antimicrobial treatment and outcomes of endocarditis caused by viridans and gallolyticus group streptococci. Clinical Infectious Diseases (2023). doi:10.1093/cid/ciad375

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