From the Guidelines
Augmentin is not the recommended treatment for Enterococcus faecalis infections, especially in cases of infective endocarditis, due to potential resistance and the availability of more effective treatment options. According to the 2015 ESC guidelines for the management of infective endocarditis 1, the recommended treatment for Enterococcus spp. infections, including E. faecalis, involves the use of ampicillin or amoxicillin in combination with an aminoglycoside, such as gentamicin. The typical adult dosage is amoxicillin 200 mg/kg/day i.v. in 4-6 doses, in combination with gentamicin 3 mg/kg/day i.v. or i.m. in 1 dose, for a duration of 6 weeks.
- Key considerations for treatment include:
- The use of ampicillin or amoxicillin in combination with gentamicin is recommended for beta-lactam and gentamicin-susceptible strains of E. faecalis.
- Vancomycin-based regimens may be used as an alternative, especially in cases of beta-lactam resistance or high-level aminoglycoside resistance.
- Susceptibility testing is crucial to confirm the effectiveness of the chosen treatment regimen.
- Monitoring of serum levels of aminoglycosides and renal function is necessary to minimize the risk of toxicity.
- Pediatric doses should not exceed adult doses, and serum vancomycin concentrations should be monitored as stated in the guidelines. The choice of treatment should be guided by the severity of the infection, the presence of any underlying conditions, and the results of susceptibility testing, as recommended by the guidelines 1.
From the Research
Enterococcus faecalis Treatment with Augmentin
- There is no direct evidence in the provided studies regarding the use of Augmentin (amoxicillin-clavulanic acid) for the treatment of Enterococcus faecalis infections.
- However, some studies suggest alternative treatment options for E. faecalis infections, such as ampicillin combined with ceftobiprole 2, 3 or high-dose daptomycin 4.
- Another study recommends the use of amoxicillin as a documented therapy for enterococcal bacteraemia, showing a better outcome compared to other antibiotic therapies 5.
- Aminoglycosides, such as gentamicin, are also recommended for the treatment of E. faecalis infections, especially in severe and bacteremic cases 6.
Alternative Treatment Options
- Ampicillin combined with ceftobiprole has shown high clinical success rates and microbiological cure in the treatment of E. faecalis invasive infections 2, 3.
- High-dose daptomycin may be effective in the treatment of enterococcal bloodstream infection and endocarditis, although more studies are needed to confirm its efficacy 4.
- Gentamicin has shown significant antibacterial efficacy against E. faecalis, especially at high dosages 6.
Considerations for Treatment
- Therapeutic drug monitoring (TDM) is recommended for optimizing medical treatments and achieving the best possible efficacy with fewer side effects 2, 3.
- The choice of antibiotic therapy should be based on the susceptibility of the E. faecalis isolate and the severity of the infection 5.
- More studies are needed to determine the optimal treatment regimen for E. faecalis infections, including the use of Augmentin 2, 4, 6, 3, 5.