From the Guidelines
Treatment for Urinary Tract Infection (UTI) caused by Enterococcus
The most effective treatment for Enterococcus urinary tract infections (UTIs) is the use of antibiotics that are effective against Enterococci, such as Ampicillin or Linezolid.
- For uncomplicated UTIs, options include:
- For complicated UTIs or in cases of vancomycin-resistant Enterococcus (VRE), Linezolid 600 mg IV or PO every 12 hours can be considered 1
- In severe cases, Daptomycin 6-12 mg/kg IV every 24 hours may be used 1 It is essential to obtain urine culture and sensitivity results to guide the selection of the most appropriate antibiotic 1.
Key Considerations
- The choice of antibiotic should be based on the severity of the infection, the presence of any underlying medical conditions, and the results of urine culture and sensitivity testing 1
- In cases of VRE, it is crucial to consider the use of antibiotics that are effective against this resistant strain, such as Linezolid or Daptomycin 1
- The duration of treatment should be individualized based on the clinical response and the severity of the infection, but typically ranges from 3-14 days 1
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. 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 Infection Cured Linezolid 600 mg every 12 hours n/N (%) Linezolid 200 mg every 12 hours n/N (%) Urinary tract 12/19 (63) 12/20 (60)
The treatment for Urinary Tract Infection (UTI) caused by Enterococcus is Linezolid 600 mg every 12 hours, with a cure rate of 63% 2.
From the Research
Treatment Options for Urinary Tract Infections (UTIs) Caused by Enterococcus
- The management of UTIs caused by Enterococcus spp has become challenging given the presence of underlying comorbidities in these patients and the limited therapeutic options available to treat multidrug-resistant (MDR) Enterococcus 3.
- Routine therapy for asymptomatic bacteriuria with MDR-Enterococcus is not recommended 3.
- Removal of indwelling urinary catheters should be considered 3.
- Appropriate antibiotic therapy selection should be guided by urine culture and susceptibility results 3.
Antibiotic Therapy for UTIs Caused by Enterococcus
- Potential oral agents active against MDR-Enterococcus that may be considered for acute uncomplicated UTI include:
- Nitrofurantoin
- Fosfomycin
- Fluoroquinolones 3
- Potential parenteral agents for the treatment of pyelonephritis and complicated UTIs caused by MDR-Enterococcus include:
- Daptomycin
- Linezolid
- Quinipristin-dalfopristin 3
- Aminoglycosides or rifampin may be considered as adjunctive therapy in serious infections 3.
Treatment of Vancomycin-Resistant Enterococcus (VRE) UTIs
- Ampicillin generally is considered the drug of choice for ampicillin-susceptible enterococcal UTIs, including VRE 4.
- Nitrofurantoin, fosfomycin, and doxycycline have intrinsic activity against enterococci, including VRE, and are possible oral options for VRE cystitis 4.
- Linezolid and daptomycin should be reserved for confirmed or suspected upper and/or bacteremic VRE UTIs among ampicillin-resistant strains 4.
- Linezolid appears effective as comparator antibiotics for the treatment of mild vancomycin-resistant Enterococcus urinary tract infection 5.