From the Guidelines
Enterococcus faecalis infections are typically treated with antibiotics, with ampicillin being the first-line treatment for susceptible strains at doses of 2 grams IV every 4-6 hours for adults, as recommended by the most recent guidelines 1. For patients with penicillin allergies, vancomycin is the alternative, administered at 15-20 mg/kg IV every 8-12 hours. In cases of serious infections like endocarditis or meningitis, combination therapy with an aminoglycoside (such as gentamicin 1 mg/kg every 8 hours) is often added to enhance bactericidal activity through synergy. Some key points to consider in the treatment of Enterococcus faecalis infections include:
- For vancomycin-resistant enterococci (VRE), linezolid (600 mg IV/oral twice daily) or daptomycin (6-8 mg/kg IV once daily) may be used, with high-dose daptomycin (8-12 mg/kg IV daily) being recommended for VRE bacteremia 1.
- Treatment duration varies by infection site: 7-14 days for urinary tract infections, 10-14 days for bacteremia, and 4-6 weeks for endocarditis.
- Source control through drainage of abscesses or removal of infected devices is crucial for successful treatment.
- E. faecalis is challenging to treat due to its intrinsic resistance to many antibiotics and ability to acquire additional resistance mechanisms, making susceptibility testing essential for guiding appropriate therapy.
- The use of combination therapy, such as daptomycin plus a beta-lactam antibiotic, may be considered in severely ill patients or those who fail treatment with traditional options 1.
- Tigecycline, fosfomycin, and nitrofurantoin may also be considered for the treatment of VRE infections, particularly in cases of urinary tract infections or intra-abdominal infections 1.
From the Research
Treatment Options for Enterococcus faecalis Infections
- The treatment of Enterococcus faecalis infections can be challenging due to the development of antibiotic resistance 2, 3, 4, 5.
- Studies have shown that combinations of antibiotics such as daptomycin and linezolid can be effective against multidrug-resistant Enterococcus faecalis 2.
- Other treatment options include the use of ampicillin plus ceftriaxone, which has been shown to be safer and more effective than ampicillin plus gentamicin in some cases 4.
- Antimicrobial susceptibility testing has revealed that Enterococcus faecalis isolates from endodontic infections are often resistant to rifampicin, but susceptible to penicillin and ampicillin 5.
- Probiotic bacteria and their products have also been shown to be effective in preventing the regrowth of Enterococcus faecalis biofilms 6.
Antibiotic Resistance and Treatment
- Enterococcus faecalis has developed resistance to many antibiotics, including ampicillin, vancomycin, and aminoglycosides 2, 3, 4.
- High-level aminoglycoside resistance has been observed in recent years, making treatment with traditional antibiotics more challenging 4.
- The use of alternative antibiotics such as linezolid, teicoplanin, and nitrofurantoin has been recommended in some cases 3.
Biofilm Treatment
- Enterococcus faecalis biofilms can be difficult to treat with traditional antibiotics, and may require alternative approaches such as the use of probiotic bacteria and their products 6.
- Sodium hypochlorite irrigation has been shown to be effective in reducing biofilm cells, but may not fully eradicate them 6.
- Conditioned medium from probiotic bacteria such as Lactobacillus plantarum and Lactobacillus casei has been shown to prevent the regrowth of treated biofilms 6.