From the Guidelines
Ciprofloxacin is not the preferred treatment for Enterococcus urinary tract infections (UTIs) due to concerns about suboptimal clinical outcomes and increasing resistance patterns. According to the European Association of Urology guidelines on urological infections, Enterococcus spp. are among the most common species found in cultures of complicated UTIs, and antimicrobial resistance is more likely in these cases 1. While some Enterococcus isolates may test susceptible to ciprofloxacin in vitro, the guidelines emphasize the importance of optimal antimicrobial therapy based on local resistance patterns and specific host factors.
Key considerations for treating Enterococcus UTIs include:
- The microbial spectrum is greater than for uncomplicated UTIs, and antimicrobial resistance is more likely 1
- Appropriate management of the urological abnormality or the underlying complicating factor is mandatory 1
- Optimal antimicrobial therapy depends on the severity of the illness at presentation, as well as local resistance patterns and specific host factors 1
Alternative treatment options for Enterococcus UTIs include:
- Amoxicillin 500 mg three times daily for 5-7 days
- Nitrofurantoin 100 mg twice daily for 5-7 days for lower urinary tract infections
- Fosfomycin 3 g as a single dose for patients with penicillin allergy
It is essential to note that using ciprofloxacin unnecessarily contributes to increasing fluoroquinolone resistance and potential adverse effects like tendinopathy and C. difficile infection. If treatment options are limited due to resistance patterns or allergies, consultation with an infectious disease specialist is recommended. The European Association of Urology guidelines recommend treatment for 7 to 14 days, depending on the severity of the illness and the underlying abnormality 1.
From the FDA Drug Label
Ciprofloxacin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections... Aerobic gram-positive microorganisms Enterococcus faecalis (Many strains are only moderately susceptible.)
- Enterococcus faecalis is noted to have many strains that are only moderately susceptible to ciprofloxacin.
- The term "moderately susceptible" implies that while ciprofloxacin may have some effect against Enterococcus faecalis, it may not be the most effective treatment option.
- Given this information, it can be inferred that ciprofloxacin may not be the best choice for treating Enterococcus urinary tract infections (UTIs) due to the moderate susceptibility of the bacteria to the drug 2.
- Therefore, the use of ciprofloxacin for Enterococcus UTIs should be approached with caution and considered on a case-by-case basis, taking into account the specific circumstances of the infection and the patient's overall health.
From the Research
Susceptibility of Enterococcus UTI to Cipro
- The susceptibility of Enterococcus urinary tract infection (UTI) to Cipro (ciprofloxacin) is a concern due to increasing resistance rates 3, 4, 5, 6, 7.
- A study from 2004 found that 43% of E. faecalis strains and 14% of E. faecium strains were sensitive to ciprofloxacin 4.
- Another study from 2013 reported that 47% of E. faecalis strains were resistant to ciprofloxacin, and the risk of resistance was higher in patients with hospital-acquired infections, those treated in urological departments, and those transferred from healthcare centers 5.
- A 2014 study found a significant correlation between resistance to fluoroquinolones, including ciprofloxacin, and siderophore production in enterococci, which may contribute to increased virulence and treatment failure 6.
- The evaluation of antimicrobial susceptibility of urine enterococci using the Vitek 2 automated system in eastern Turkey found that 18.1% of E. faecalis and 72.7% of E. faecium isolates were resistant to ciprofloxacin 7.
Resistance Rates
- The resistance rates to ciprofloxacin vary among different species of Enterococcus, with E. faecium generally showing higher resistance rates than E. faecalis 4, 5, 7.
- The use of ciprofloxacin as a treatment option for Enterococcus UTI may be limited due to high resistance rates, particularly in patients with risk factors for resistance 5.