From the Guidelines
Augmentin is not the preferred treatment for Enterococcus faecalis urinary tract infections (UTIs) in patients with Foley catheters, and alternative treatments such as ampicillin, nitrofurantoin, or fosfomycin should be considered based on culture and sensitivity results. For catheter-associated UTIs caused by E. faecalis, ampicillin or amoxicillin alone are usually preferred as first-line treatments if the organism is susceptible 1. The use of Augmentin, which adds clavulanic acid to inhibit beta-lactamase enzymes, is not necessary since E. faecalis rarely produces these enzymes.
When treating UTIs in patients with Foley catheters, it is essential to consider the following:
- Antibiotic selection should be guided by culture and sensitivity results, as catheter-associated infections often involve resistant organisms 1.
- Treatment typically lasts 7-14 days, depending on symptom severity 1.
- Catheter management is crucial, and either removing the catheter if possible or replacing it before starting antibiotics can improve treatment outcomes 1.
- If the patient has renal impairment, the dose of the chosen antibiotic may need adjustment.
- Alternative treatments for resistant strains might include nitrofurantoin, fosfomycin, or vancomycin, depending on susceptibility testing 1.
In terms of specific treatment durations, a 7-day regimen is recommended for patients with prompt resolution of symptoms, while 10-14 days of treatment is recommended for those with a delayed response 1. A 5-day regimen of levofloxacin may be considered in patients with CA-UTI who are not severely ill, but data are insufficient to make such a recommendation about other fluoroquinolones 1.
From the Research
Treatment Options for Enterococcus faecalis UTI
- The use of augmentin for Enterococcus faecalis UTI with a Foley catheter is not explicitly mentioned in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that the treatment of Enterococcus faecalis UTI should be guided by urine culture and susceptibility results 2, 3.
- Some potential treatment options for Enterococcus faecalis UTI include:
- Ampicillin, which is generally considered the drug of choice for ampicillin-susceptible enterococcal UTIs 2.
- Nitrofurantoin, fosfomycin, and doxycycline, which have intrinsic activity against enterococci and may be used as oral options for VRE cystitis 2, 3.
- Linezolid and daptomycin, which should be reserved for confirmed or suspected upper and/or bacteremic VRE UTIs among ampicillin-resistant strains 2.
- Quinupristin-dalfopristin and tigecycline, which may be considered on a case-by-case basis due to concerns of toxicity, resistance, and insufficient supportive data 2, 3.
Considerations for Foley Catheter Use
- The use of a Foley catheter can increase the risk of developing a catheter-associated urinary tract infection (CAUTI) 5.
- Removal of the Foley catheter should be considered as part of the treatment plan for Enterococcus faecalis UTI 3.
- Antibiotic-sparing treatments, such as antibody-based therapy, may be effective against diverse enterococcal isolates, including vancomycin-resistant enterococci, during CAUTI 5.