From the Guidelines
Vancomycin is not an effective treatment for urinary tract infections (UTIs) due to its poor urinary excretion and lack of efficacy against gram-negative bacteria, which are the most common cause of UTIs. The most recent and highest quality study, published in 2019 1, recommends first-line therapy with nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin for the treatment of symptomatic UTIs in women. These antibiotics have been shown to be effective in achieving clinical and bacteriological cure, with relatively little to distinguish one agent from another in terms of efficacy.
Some key points to consider when treating UTIs include:
- The choice of antibiotic should be based on the local antibiogram and the patient's allergy history
- First-line agents, such as nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin, are preferred due to their effectiveness and lower risk of collateral damage
- Second-line or alternate therapies, such as fluoroquinolones or extended-spectrum cephalosporins, may be used in cases of resistance or allergy
- Vancomycin is generally reserved for serious infections caused by resistant gram-positive organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), and is not typically recommended for UTIs.
It's worth noting that the 2011 guidelines from the Infectious Diseases Society of America 1 also discuss the importance of considering resistance prevalence and collateral damage when choosing UTI treatments. However, the 2019 study 1 provides more recent and relevant guidance on the treatment of UTIs. In summary, vancomycin is not a recommended treatment for UTIs, and empiric therapy with a standard agent, such as nitrofurantoin or trimethoprim-sulfamethoxazole, should be initiated while awaiting culture results.
From the Research
Effectiveness of Vancomycin for Treating UTIs
- Vancomycin is not typically used to treat urinary tract infections (UTIs) caused by vancomycin-resistant enterococci (VRE) due to its resistance pattern 2.
- Instead, other antimicrobials such as ampicillin, nitrofurantoin, fosfomycin, and doxycycline have shown intrinsic activity against enterococci, including VRE, and are possible oral options for VRE cystitis 2.
- Daptomycin has been shown to be effective in treating VRE UTIs, with a case series demonstrating clinical cure and VRE eradication in all patients treated with daptomycin 3.
- Other potential treatments for VRE UTIs include linezolid, quinupristin-dalfopristin, and tigecycline, although their use may be limited by concerns of toxicity, resistance, and insufficient supportive data 2, 4.
Antibiotic Susceptibility Trends
- A surveillance program in the United Kingdom found that the prevalence of vancomycin-resistant enterococci in urine cultures remained stable over a decade, with emerging resistance to nitrofurantoin and fluctuating resistance to ampicillin 5.
- Another study found that aminopenicillins may be a viable option for treating VRE UTIs, regardless of the organism's ampicillin susceptibility, with similar rates of clinical cure and 30-day readmission or retreatment compared to non-β-lactam antibiotics 6.
Treatment Options
- The choice of treatment for VRE UTIs depends on various factors, including the severity of the infection, the patient's renal function, and the presence of underlying medical conditions 2, 3, 4.
- A treatment algorithm for VRE UTIs has been proposed, taking into account the susceptibility patterns of VRE and the potential side effects of different antimicrobials 2.