From the Guidelines
For a previous Enterococcus urinary tract infection in an inpatient setting, the recommended treatment is Linezolid 600 mg IV or PO every 12 hours, as it is the most effective option according to the latest guidelines 1.
Treatment Options
- Linezolid 600 mg IV or PO every 12 hours is recommended for enterococcal infection, with treatment duration dependent on the site of infection and clinical response 1.
- Alternative options for uncomplicated urinary tract infections due to VRE include fosfomycin 3 g PO as a single dose, nitrofurantoin 100 mg PO every 6 hours, or high-dose ampicillin (18-30 g IV daily) or amoxicillin (500 mg PO/IV every 8 hours) 1.
Considerations
- Treatment should be guided by antimicrobial susceptibility testing, as Enterococcus species can exhibit resistance to multiple antibiotics 1.
- Combination therapy with an aminoglycoside like gentamicin may be necessary for complicated or resistant infections 1.
- Adequate hydration should be maintained throughout treatment, and urinary catheters should be removed if present.
- Follow-up urine cultures are recommended 1-2 weeks after completing antibiotics to confirm resolution.
Important Notes
- Enterococcus infections require targeted therapy due to intrinsic resistance to many commonly used antibiotics, including cephalosporins and trimethoprim-sulfamethoxazole 1.
- The choice of antibiotic should be based on the latest guidelines and the specific circumstances of the patient, including the severity of the infection and any underlying medical conditions 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 recommended treatment for a previous Enterococcus urinary tract infection (UTI) in an inpatient setting is Linezolid 600 mg every 12 hours, with a cure rate of 63% 2.
- Key points:
- Linezolid is effective against vancomycin-resistant Enterococcal infections.
- The cure rate for urinary tract infections is 63% for the high-dose arm.
- The difference in cure rates between the high-dose and low-dose arms was not statistically significant.
From the Research
Treatment Options for Enterococcus UTI in Inpatient Setting
- The recommended treatment for Enterococcus UTI in an inpatient setting depends on the susceptibility of the isolate and the severity of the infection 3, 4, 5.
- For ampicillin-susceptible enterococcal UTIs, ampicillin is generally considered the drug of choice 3.
- For vancomycin-resistant enterococcal (VRE) UTIs, treatment options include:
- Nitrofurantoin, fosfomycin, and doxycycline for uncomplicated cystitis 3, 4, 5.
- Linezolid and daptomycin for confirmed or suspected upper and/or bacteremic VRE UTIs among ampicillin-resistant strains 3, 5, 6.
- Quinupristin-dalfopristin and tigecycline may be considered on a case-by-case basis due to concerns of toxicity, resistance, and insufficient supportive data 3, 7, 5.
- Combination therapy may be recommended for complicated infections and/or prolonged therapy 7, 6.
- Removal of indwelling urinary catheters should be considered, and routine therapy for asymptomatic bacteriuria with MDR-Enterococcus is not recommended 4.
- Treatment should be guided by urine culture and susceptibility results 4.