From the Guidelines
The treatment for vaginal Enterococcus faecalis infection should be linezolid 600 mg IV or PO every 12 hours, as recommended by the most recent guidelines 1. This recommendation is based on the strongest and most recent evidence available, which prioritizes the treatment of enterococcal infections with effective antibiotics.
Key Considerations
- The treatment duration is dependent on the site of infection and clinical response, as stated in the guidelines 1.
- It is essential to differentiate colonization from true infection prior to empiric prescription of anti-VRE antimicrobial agents, as noted in the study 1.
- Maintaining good hygiene is crucial during treatment, including wearing cotton underwear, avoiding douches, and wiping from front to back after using the toilet.
- Patients should complete the full course of antibiotics even if symptoms improve before completion.
Alternative Options
- High-dose ampicillin (18-30 g IV daily) or amoxicillin (500 mg PO/IV every 8 hours) may be considered for uncomplicated urinary tract infections due to VRE, as suggested in the study 1.
- However, linezolid remains the preferred treatment option due to its effectiveness and recommendation in the guidelines 1.
Important Notes
- Enterococcus faecalis can be challenging to treat due to its intrinsic resistance to several antibiotics and ability to acquire additional resistance mechanisms.
- The bacterium normally resides in the gastrointestinal tract but can cause opportunistic infections when it colonizes the vaginal area, particularly in women with altered vaginal flora or compromised immune systems.
From the FDA Drug Label
Daptomycin has been shown to be active against most isolates of the following microorganisms both in vitro and in clinical infections [see Indications and Usage (1)] Gram-Positive Bacteria Enterococcus faecalis (vancomycin-susceptible isolates only)
The treatment for vaginal Enterococcus faecalis infection is not directly addressed in the provided drug label. However, based on the information provided, daptomycin has been shown to be active against vancomycin-susceptible isolates of Enterococcus faecalis.
- Key points:
- Daptomycin is effective against Gram-positive bacteria, including Enterococcus faecalis (vancomycin-susceptible isolates only).
- The provided drug label does not specifically address the treatment of vaginal Enterococcus faecalis infections.
- Daptomycin is administered via IV infusion, which may not be suitable for the treatment of vaginal infections.
- Vancomycin-resistant isolates of Enterococcus faecalis are not susceptible to daptomycin based on the provided information 2.
From the Research
Treatment for Vaginal Enterococcus faecalis Infection
- The recommended treatment of aerobic vaginitis (AV) caused by Enterococcus faecalis includes a combination of therapy such as: antibacterial (antiseptic and antibiotic), hormonal, non-steroidal anti-inflammatory and/or probiotics, which can be prescribed in the form of local or systemic therapy 3.
- Most authors suggest that therapy be based on microscopic or microbiological findings using a topical antibiotic for the infectious agent, a topical steroid to reduce inflammation, and estrogen to treat atrophy 3.
- Daptomycin has been shown to be rapidly bactericidal against Enterococcus faecalis at human peak free serum concentrations, making it a useful option for the treatment of Gram-positive infections, including those caused by E. faecalis 4.
- Vancomycin has also been shown to be effective against E. faecalis, with no resistance reported in one study 5.
Factors Involved in Vaginal Colonization and Persistence
- A study using a mouse vaginal colonization model found that Enterococcus faecalis can colonize the murine vaginal tract, and that both vancomycin-resistant and -sensitive strains can colonize the vaginal tract 6.
- The study also found that mutants deficient in ethanolamine catabolism or in the type VII secretion system were attenuated in persisting during vaginal colonization, suggesting that multiple factors contribute to E. faecalis persistence in the reproductive tract 6.
Impact of Enterococcus faecalis on Antimicrobial Activity
- One study found that the presence of Enterococcus faecalis can impact the bactericidal activities of certain antimicrobials, such as arbekacin, daptomycin, linezolid, and tigecycline, against methicillin-resistant Staphylococcus aureus in a mixed-pathogen pharmacodynamic model 7.
- The study found that the inhibitory effect of E. faecalis contributed significantly to its overall antimicrobial impact on S. aureus, and that this contribution was enhanced or improved compared to the activity of each antimicrobial alone 7.