When Less Is More: Volume Considerations in the Treatment of Enterococcus faecalis Endocarditis

Sami El-Dalati; William Harris

doi:10.1093/ofid/ofag199

When Less Is More: Volume Considerations in the Treatment of Enterococcus faecalis Endocarditis

Sami El-Dalati
, William Harris

Internal Medicine

Research output: Contribution to journal › Comment/debate

Abstract

A 6-week regimen of intravenous ampicillin and ceftriaxone is currently the consensus, guideline-recommended, first-line treatment for Enterococcus faecalis endocarditis. This regimen is associated with significant salt and volume administration in a patient population susceptible to the development of hypervolemia and heart failure, which are associated with worse clinical outcomes. As a consequence of Hurricane Helene, the United States experienced significant intravenous fluid shortages in 2024 and 2025, prompting hospitals to switch from infusion delivery to push administration of many medications, without reported deleterious effects. Push administration of ampicillin and ceftriaxone and the evidence-based use of partial oral antibiotic therapy are treatment strategies that may help reduce the incidence of hypervolemia and/or heart failure in patients with E faecalis endocarditis.

Original language	English
Article number	ofag199
Journal	Open Forum Infectious Diseases
Volume	13
Issue number	5
DOIs	https://doi.org/10.1093/ofid/ofag199
State	Published - May 2026

Bibliographical note

Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

endocarditis
enterococcal infections
heart failure
oral antibiotic treatment

ASJC Scopus subject areas

Oncology
Infectious Diseases

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10.1093/ofid/ofag199

Cite this

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title = "When Less Is More: Volume Considerations in the Treatment of Enterococcus faecalis Endocarditis",

abstract = "A 6-week regimen of intravenous ampicillin and ceftriaxone is currently the consensus, guideline-recommended, first-line treatment for Enterococcus faecalis endocarditis. This regimen is associated with significant salt and volume administration in a patient population susceptible to the development of hypervolemia and heart failure, which are associated with worse clinical outcomes. As a consequence of Hurricane Helene, the United States experienced significant intravenous fluid shortages in 2024 and 2025, prompting hospitals to switch from infusion delivery to push administration of many medications, without reported deleterious effects. Push administration of ampicillin and ceftriaxone and the evidence-based use of partial oral antibiotic therapy are treatment strategies that may help reduce the incidence of hypervolemia and/or heart failure in patients with E faecalis endocarditis.",

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AU - Harris, William

N1 - Publisher Copyright: © The Author(s) 2026. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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N2 - A 6-week regimen of intravenous ampicillin and ceftriaxone is currently the consensus, guideline-recommended, first-line treatment for Enterococcus faecalis endocarditis. This regimen is associated with significant salt and volume administration in a patient population susceptible to the development of hypervolemia and heart failure, which are associated with worse clinical outcomes. As a consequence of Hurricane Helene, the United States experienced significant intravenous fluid shortages in 2024 and 2025, prompting hospitals to switch from infusion delivery to push administration of many medications, without reported deleterious effects. Push administration of ampicillin and ceftriaxone and the evidence-based use of partial oral antibiotic therapy are treatment strategies that may help reduce the incidence of hypervolemia and/or heart failure in patients with E faecalis endocarditis.

AB - A 6-week regimen of intravenous ampicillin and ceftriaxone is currently the consensus, guideline-recommended, first-line treatment for Enterococcus faecalis endocarditis. This regimen is associated with significant salt and volume administration in a patient population susceptible to the development of hypervolemia and heart failure, which are associated with worse clinical outcomes. As a consequence of Hurricane Helene, the United States experienced significant intravenous fluid shortages in 2024 and 2025, prompting hospitals to switch from infusion delivery to push administration of many medications, without reported deleterious effects. Push administration of ampicillin and ceftriaxone and the evidence-based use of partial oral antibiotic therapy are treatment strategies that may help reduce the incidence of hypervolemia and/or heart failure in patients with E faecalis endocarditis.

KW - endocarditis

KW - enterococcal infections

KW - heart failure

KW - oral antibiotic treatment

UR - https://www.scopus.com/pages/publications/105039513793

UR - https://www.scopus.com/pages/publications/105039513793#tab=citedBy

U2 - 10.1093/ofid/ofag199

DO - 10.1093/ofid/ofag199

M3 - Comment/debate

AN - SCOPUS:105039513793

SN - 2328-8957

VL - 13

JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

IS - 5

M1 - ofag199

ER -

When Less Is More: Volume Considerations in the Treatment of Enterococcus faecalis Endocarditis

Abstract

Bibliographical note

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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