From the Guidelines
The recommended treatment for Aerococcus urinary tract infections (UTIs) is not explicitly mentioned in the provided evidence, but based on the general guidelines for UTI treatment, nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days, or fosfomycin as a single dose can be considered for uncomplicated cystitis. When considering the treatment of Aerococcus UTIs, it's essential to note that the provided evidence focuses on the treatment of uncomplicated cystitis and pyelonephritis, primarily caused by Escherichia coli 1.
- The American College of Physicians recommends short-course antibiotics for UTIs, with options including nitrofurantoin, TMP-SMZ, or fosfomycin for uncomplicated cystitis 1.
- For uncomplicated pyelonephritis, fluoroquinolones for 5 to 7 days or TMP-SMZ for 14 days are recommended, based on antibiotic susceptibility 1.
- Given that Aerococcus species are gram-positive cocci and their susceptibility to antibiotics may vary, it is crucial to guide treatment by antimicrobial susceptibility testing whenever possible.
- Patients should be advised to complete the full course of antibiotics and maintain adequate hydration to help flush bacteria from the urinary tract.
- It's also important to consider the potential for resistance and the specific characteristics of the infecting organism when selecting an antibiotic regimen.
From the Research
Aerococcus UTI Treatment
The recommended treatment for Aerococcus urinary tract infection (UTI) is based on several studies that have investigated the effectiveness of different antibiotics against this type of bacteria.
- Nitrofurantoin is a commonly prescribed antibiotic for Aerococcus UTI, achieving clinical and microbiological success in 71/76% of cases of A. urinae UTI, and 42/50% of cases of A. sanguinicola UTI 2.
- Pivmecillinam is also effective in treating A. urinae cystitis, while ciprofloxacin is effective in treating pyelonephritis caused by A. urinae 2.
- Penicillin, amoxicillin, and nitrofurantoin are recommended for treating A. urinae infection, especially in older adults with multimorbidity and urologic cancer 3.
- Nitroxoline has been shown to be highly active against A. urinae, but not against A. sanguinicola, and could be an alternative oral drug for treating A. urinae UTI 4.
- Other antibiotics such as ampicillin, vancomycin, and rifampicin have also been shown to be effective against A. urinae, with low MICs and no high-level aminoglycoside resistance found 5.
Antibiotic Resistance
- Resistance to ciprofloxacin is common, with 10.9% of A. urinae isolates showing resistance 4.
- The use of ciprofloxacin extended release has been shown to be effective in treating UTIs, with a high clinical success rate and convenient once-daily dosing 6.
- However, the increasing resistance to antibiotics highlights the need for prompt and culture-specific treatment, as well as the importance of antibiotic susceptibility testing 3.
Treatment Options
- The treatment options for Aerococcus UTI include penicillins, nitrofurantoin, pivmecillinam, and ciprofloxacin, depending on the severity of the infection and the patient's medical history 2, 3, 5.
- In severe cases, such as endocarditis, combination therapy with gentamicin may be beneficial 5.
- Vancomycin in combination with gentamicin may be an alternative option for patients allergic to penicillin 5.