From the Guidelines
Rocephin (ceftriaxone) does not adequately cover Enterococcus faecalis due to its intrinsic resistance to cephalosporins. Enterococcus faecalis has low-affinity penicillin-binding proteins that prevent ceftriaxone from effectively disrupting cell wall synthesis 1. For infections caused by Enterococcus faecalis, more appropriate antibiotic choices would include ampicillin or penicillin (if the strain is susceptible), or vancomycin for penicillin-resistant strains. In serious infections like endocarditis or bacteremia, combination therapy with an aminoglycoside (such as gentamicin) is often recommended for synergistic killing 1.
Key Points to Consider
- Enterococcus faecalis is resistant to ceftriaxone and other cephalosporins, making them ineffective for treatment of enterococcal endocarditis 1.
- The combination of ampicillin plus ceftriaxone may be effective for aminoglycoside nonsusceptible Enterococcus faecalis strains, but this is not a standard treatment regimen 1.
- Vancomycin-resistant enterococci may cause IE, and treatment options are limited, with linezolid and daptomycin showing activity against vancomycin-resistant enterococci in vitro 1.
- Consultation with an infectious disease specialist is advisable to determine the most appropriate antibiotic regimen based on susceptibility testing and the specific infection site 1.
Treatment Recommendations
- For susceptible strains of Enterococcus faecalis, ampicillin or penicillin plus gentamicin is a recommended treatment regimen 1.
- For penicillin-resistant strains, vancomycin plus gentamicin is a recommended treatment regimen 1.
- The duration of therapy depends on the specific infection site and the duration of symptoms before initiation of therapy 1.
From the Research
Effectiveness of Rocephin (Ceftriaxone) Against Enterococcus faecalis
- Rocephin, also known as ceftriaxone, is a third-generation cephalosporin antibiotic with a broad spectrum of activity against Gram-positive and Gram-negative bacteria 2.
- The effectiveness of ceftriaxone against Enterococcus faecalis has been studied in various clinical trials, with some studies suggesting that it can be used in combination with ampicillin to treat Enterococcus faecalis infective endocarditis 3, 4, 5.
- One study found that the combination of ampicillin and ceftriaxone was as effective as ampicillin and gentamicin for treating Enterococcus faecalis infective endocarditis, with lower rates of adverse events and renal failure 4.
- Another study found that the combination of ampicillin and ceftriaxone was effective in treating Enterococcus faecalis bloodstream infections and infective endocarditis, with high cure rates and low rates of relapse 6.
Spectrum of Activity of Ceftriaxone
- Ceftriaxone has a broad spectrum of activity against Gram-positive and Gram-negative bacteria, including Enterococcus faecalis 2.
- However, its activity against Enterococcus faecalis is generally less than that of other antibiotics, such as ampicillin and gentamicin 2.
- Ceftriaxone is often used in combination with other antibiotics, such as ampicillin, to treat serious infections caused by Enterococcus faecalis 3, 4, 5, 6.
Clinical Implications
- The use of ceftriaxone in combination with ampicillin may be a viable treatment option for Enterococcus faecalis infective endocarditis, particularly in patients with renal impairment or those who are at risk of nephrotoxicity 4, 5.
- However, more research is needed to fully elucidate the optimal treatment regimen for Enterococcus faecalis infections and to improve patient outcomes 6.