From the FDA Drug Label
The cure rates for the ITT population with documented vancomycin-resistant enterococcal infection at baseline are presented in Table 15 by source of infection. These cure rates do not include patients with missing or indeterminate outcomes. The cure rate was higher in the high-dose arm than in the low-dose arm, although the difference was not statistically significant at the 0. 05 level. Table 15. Cure Rates at the Test-of-Cure Visit for ITT Adult Patients with Documented Vancomycin-Resistant Enterococcal Infections at Baseline Source of InfectionCured ZYVOX600 mg q12hn/N (%)ZYVOX200 mg q12hn/N (%)
- Includes sources of infection such as hepatic abscess, biliary sepsis, necrotic gall bladder, pericolonic abscess, pancreatitis, and catheter-related infection Any site39/58 (67)24/46 (52) Any site with associated bacteremia10/17 (59)4/14 (29) Bacteremia of unknown origin5/10 (50)2/7 (29) Skin and skin structure9/13 (69)5/5 (100) Urinary tract12/19 (63)12/20 (60) Pneumonia 2/3 (67)0/1 (0) Other*11/13 (85)5/13 (39)
The best antibiotic for enterococcus UTI on a kidney transplant patient is linezolid (ZYVOX), with a cure rate of 63% at a dose of 600 mg q12h and 60% at a dose of 200 mg q12h 1.
From the Research
For a kidney transplant patient with an enterococcus UTI, ampicillin is typically the first-line antibiotic choice if the organism is susceptible, usually dosed at 500 mg orally four times daily for 7-14 days. If the patient has a penicillin allergy or the organism shows resistance, vancomycin (1 gram IV twice daily, adjusted for renal function) or linezolid (600 mg orally twice daily) may be used 2. Some key points to consider when treating transplant patients include:
- Checking for drug interactions with immunosuppressants, particularly with macrolides and fluoroquinolones
- Dosing adjustments based on the patient's current kidney function
- Susceptibility testing due to increasing resistance patterns among enterococci
- Monitoring patients closely for clinical improvement and potential nephrotoxicity from antibiotics like vancomycin 3
- Enterococci are intrinsically resistant to cephalosporins and trimethoprim-sulfamethoxazole, making these ineffective treatment options In cases of vancomycin-resistant enterococci, daptomycin may be an effective alternative, as suggested by a case report where daptomycin successfully treated a UTI caused by vancomycin-resistant Enterococcus faecium in a renal transplant recipient 4. Nitrofurantoin (100 mg orally twice daily) can be considered for uncomplicated lower UTIs if renal function is adequate (eGFR >30 ml/min) 2. Treatment should be guided by urine culture results, and patients should be monitored closely for clinical improvement and potential nephrotoxicity from antibiotics like vancomycin 5, 3.