Recommendations for the treatment of streptococcal and enterococcal endocarditis are based on old efficacy studies, but the starting doses have never been reassessed and are associated with significant adverse events. Based on data from other serious infections, we suggest that maintaining a concentration of β-lactams higher than 4–6 times the responsible bacteria MIC 100% of the time in the heart of the vegetation would be a pertinent therapeutic objective. The data point to a diffusion gradient of β-lactams in the vegetation. Yet, so far as is known, the ratio of antibiotic concentration at steady state between plasma and vegetation cannot be completely determined. Answering this crucial question would make it possible for each patient to have a targeted β-lactam plasma concentration, according to the MIC for the responsible bacteria. This would lead the way to personalized antibiotherapy and allow a safe switch to oral medication.

中文翻译：

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链球菌和肠球菌心内膜炎：个体化抗生素治疗的时间？

治疗链球菌和肠球菌心内膜炎的建议基于旧的疗效研究，但从未重新评估起始剂量，并且与显着不良事件相关。根据来自其他严重感染的数据，我们建议在植被中心 100% 的时间内保持 β-内酰胺浓度高于负责任细菌 MIC 的 4-6 倍将是一个相关的治疗目标。数据指向植被中β-内酰胺的扩散梯度。然而，就目前所知，血浆和植被之间稳态时抗生素浓度的比率不能完全确定。根据负责细菌的 MIC，回答这个关键问题将使每位患者都有可能获得目标 β-内酰胺血浆浓度。