Is Ceftin (Cefuroxime) effective against Enterococcus faecalis infections?

Ceftin (Cefuroxime) Is Not Effective Against Enterococcus faecalis Infections

Ceftin (cefuroxime) is not effective against Enterococcus faecalis infections and should not be used as monotherapy for treating these infections. 1 Enterococci, including E. faecalis, have intrinsic resistance to cephalosporins, making Ceftin an inappropriate choice for treating enterococcal infections.

Recommended Treatment Options for E. faecalis Infections

First-Line Therapy

• Ampicillin-based regimens: Ampicillin is the drug of choice for enterococcal infections 1, 2
  • Ampicillin 2g IV every 4 hours (or 200 mg/kg/day IV divided every 4-6 hours) 1, 2
  • For synergistic effect in serious infections: Add gentamicin 3 mg/kg/day IV in 1 dose for 2-6 weeks 1

Alternative Regimens for Serious Infections

• Ampicillin plus ceftriaxone: This combination shows synergistic activity against E. faecalis 3, 4

  • Ampicillin 2g IV every 4 hours plus ceftriaxone 2g IV every 12 hours 1, 3
  • Particularly useful for patients with high-level aminoglycoside resistance (HLAR) or at risk for nephrotoxicity 3

• Vancomycin-based regimen (for penicillin-allergic patients):

  • Vancomycin 30 mg/kg/day IV in 2 doses plus gentamicin 3 mg/kg/day 1

For Vancomycin-Resistant Enterococci (VRE)

• Linezolid: 600 mg IV/PO every 12 hours (for monomicrobial infections) 1, 2
• Tigecycline: 100 mg IV loading dose, then 50 mg IV every 12 hours (for polymicrobial infections) 1, 2
• Daptomycin: 8-12 mg/kg IV daily (particularly for bloodstream infections) 1, 2

Why Ceftin (Cefuroxime) Is Ineffective

Cephalosporins, including Ceftin (cefuroxime), have poor activity against enterococci 1. The 2022 guidelines on treatment of multidrug-resistant organisms specifically state that "ceftaroline is a novel fifth-generation cephalosporin which exhibits broad-spectrum activity against Gram-positive bacteria but has poor activity against enterococcus and should not be empirically used for the treatment of VRE infections" 1. If even the newest fifth-generation cephalosporins have poor activity against enterococci, second-generation cephalosporins like cefuroxime would be even less effective.

Important Clinical Considerations

• Differentiate colonization from true infection before initiating therapy 1

• Duration of therapy depends on infection site:

  • Endocarditis: 4-6 weeks for native valve, 6 weeks for prosthetic valve 2
  • Uncomplicated infections: 7-14 days 2
  • Bloodstream infections with central venous catheters: 10-14 days 2

• Monitoring recommendations:

  • For aminoglycoside therapy: Monitor renal function weekly 1, 2
  • For daptomycin: Monitor creatine kinase (CK) levels regularly 2

Synergistic Combinations

Research has demonstrated that while cephalosporins alone are ineffective against E. faecalis, certain combinations can be synergistic:

• Ampicillin plus ceftriaxone shows in vitro and in vivo synergism against E. faecalis, including strains with high-level aminoglycoside resistance 4
• This synergistic effect is not seen with cefuroxime (Ceftin) but specifically with third-generation cephalosporins like ceftriaxone 3, 4, 5

In conclusion, when treating E. faecalis infections, clinicians should avoid Ceftin (cefuroxime) and instead choose appropriate agents such as ampicillin, ampicillin plus gentamicin, or ampicillin plus ceftriaxone depending on the severity of infection and patient factors.