Treatment of Enterococcus Vaginal Infection with Amoxicillin
For enterococcal vaginal infection, amoxicillin should be administered at a dose of 500 mg orally three times daily for 5-7 days.
Rationale for Treatment Selection
Enterococcal vaginal infections are not specifically addressed in most sexually transmitted infection or vaginitis guidelines, as they are less common than other causes of vaginal infections. However, evidence supports the use of amoxicillin as an effective treatment option.
Dosage Recommendation
This recommendation is based on guidelines for uncomplicated urinary tract infections caused by enterococci, which can be extrapolated to vaginal infections given the similar microbial susceptibility patterns.
Treatment Considerations
Antibiotic Selection
- Enterococci are generally susceptible to amoxicillin/ampicillin 1, 3
- Alternative options if amoxicillin cannot be used:
Resistance Considerations
- Check for ampicillin resistance, as some enterococcal strains may be resistant 4
- If the infection is caused by vancomycin-resistant enterococci (VRE), alternative treatments such as linezolid should be considered 1
Clinical Pearls
- A single dose of ampicillin/amoxicillin may not be sufficient to eradicate enterococci from the genital tract 5
- Complete the full course of antibiotics even if symptoms improve before completion
- Ensure adequate hydration during treatment 2
Monitoring and Follow-up
- Clinical improvement should be expected within 48-72 hours of starting treatment
- If symptoms persist after completing the full course, consider:
- Obtaining cultures with susceptibility testing
- Evaluating for potential resistant organisms
- Assessing for other causes of vaginitis
Special Situations
Pregnancy
- Amoxicillin is generally considered safe during pregnancy
- Avoid doxycycline, fluoroquinolones, and other potentially teratogenic antibiotics 1
Recurrent Infections
- Consider longer treatment duration (7-10 days)
- Evaluate for underlying conditions that may predispose to recurrent infections
- Partner treatment may be considered, although enterococcal vaginal infections are not typically considered sexually transmitted 6
Remember that while bacterial vaginosis treatment guidelines exist 1, enterococcal vaginal infections represent a distinct clinical entity requiring targeted antimicrobial therapy based on the organism's susceptibility patterns.