Treatment of Enterococcus faecalis Vaginal Infection
Amoxicillin 500 mg orally three times daily for 5-7 days is the recommended treatment for Enterococcus faecalis vaginal infection. 1
First-line Treatment Options
The American College of Obstetricians and Gynecologists supports amoxicillin as an effective treatment option for enterococcal vaginal infections. The recommended dosage is:
- Amoxicillin 500 mg orally every 8 hours (three times daily) for 5-7 days 1
Alternative Treatment Options
For patients with penicillin allergy or when amoxicillin cannot be used, the following alternatives are recommended:
- Nitrofurantoin 100 mg orally four times daily for 5-7 days 1
- Fosfomycin 3 g orally as a single dose 1
- Linezolid 600 mg orally twice daily for 5-7 days 1
Special Considerations
Antimicrobial Resistance
Enterococcus faecalis can develop resistance to multiple antibiotics. Recent studies show that while resistance to erythromycin (71.24%) and ciprofloxacin (49.67%) is common, sensitivity to vancomycin and linezolid remains high 2.
Vancomycin-Resistant Enterococci (VRE)
If the infection is caused by vancomycin-resistant enterococci:
- Linezolid 600 mg orally twice daily for 5-7 days is the preferred treatment 1, 3
- Linezolid has shown a 92.6% response rate against VRE infections 3
Fluoroquinolones (including Levofloxacin)
- Fluoroquinolones should be avoided for uncomplicated infections due to an unfavorable risk-benefit ratio 1
- Studies specifically examining levofloxacin against Enterococcus faecalis have shown limited efficacy when used alone 4
- When levofloxacin was tested in combination with vancomycin against high-level aminoglycoside-resistant enterococci, synergistic effects were rarely observed 4
Treatment Duration and Assessment
- A 5-7 day treatment course is typically sufficient for uncomplicated vaginal infections 1
- Clinical improvement should be expected within 48-72 hours of starting treatment 1
- If symptoms persist after completing the full course:
- Obtain cultures with susceptibility testing
- Evaluate for potential resistant organisms
- Assess for other causes of vaginitis 1
Important Caveats
- Routine post-treatment cultures are not indicated if symptoms resolve 1
- For persistent or recurrent symptoms within 2 weeks, obtain culture and susceptibility testing 1
- Patients should be advised to ensure adequate hydration during treatment 1
- Amoxicillin is generally considered safe during pregnancy, but fluoroquinolones should be avoided 1
- Nitrofurantoin should not be used in patients with CrCl <30 mL/min or in pregnant patients near term 1
While levofloxacin has been studied for enterococcal infections, current guidelines do not recommend it as first-line therapy for E. faecalis vaginal infections due to increasing resistance patterns and the availability of more effective alternatives with better safety profiles.