From the Guidelines
Daptomycin at a dose of 8-12 mg/kg IV daily is recommended as a first-line treatment for vancomycin-resistant Enterococcus faecium (VRE) infections, particularly for bloodstream infections and complicated intra-abdominal infections. This recommendation is based on the most recent and highest quality study available, which demonstrated the efficacy and safety of high-dose daptomycin in treating VRE infections 1.
Other effective antibiotics against Enterococcus faecium include:
- Linezolid (600 mg IV/oral twice daily) for pneumonia, bloodstream infections, and complicated urinary tract infections 1
- Tigecycline (100 mg IV loading dose, then 50 mg IV every 12 hours) for intra-abdominal infections 1
- Fosfomycin (3 g PO single dose) or nitrofurantoin (100 mg PO every 6 hours) for uncomplicated urinary tract infections 1
- High-dose ampicillin (18-30 g IV daily) or amoxicillin (500 mg PO/IV every 8 hours) for uncomplicated urinary tract infections 1
It is essential to note that the treatment of Enterococcus faecium infections should always be guided by culture results and antibiotic susceptibility testing due to the organism's complex resistance patterns. Combination therapy with gentamicin may be considered for synergy in severe cases like endocarditis. Infectious disease consultation is recommended for managing patients with enterococcal infections, particularly those with vancomycin-resistant strains.
The choice of antibiotic and duration of treatment should be individualized based on the site of infection, underlying comorbidities, and initial response to therapy. Monitoring of creatine kinase levels is recommended when using high-dose daptomycin.
In summary, the treatment of Enterococcus faecium infections requires a tailored approach, taking into account the severity of the infection, the susceptibility pattern of the organism, and the patient's underlying health status. Daptomycin at a dose of 8-12 mg/kg IV daily is a recommended first-line treatment for VRE infections, and other antibiotics may be considered based on the specific clinical scenario and susceptibility testing results.
From the FDA Drug Label
Daptomycin has been shown to be active against most isolates of the following microorganisms both in vitro and in clinical infections Gram-Positive Bacteria Enterococcus faecalis (vancomycin-susceptible isolates only) Staphylococcus aureus (including methicillin-resistant isolates) Streptococcus agalactiae Streptococcus dysgalactiae subsp. equisimilis Streptococcus pyogenes The following in vitro data are available, but their clinical significance is unknown At least 90 percent of the following bacteria exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for daptomycin against isolates of similar genus or organism group. However, the efficacy of daptomycin in treating clinical infections caused by these bacteria has not been established in adequate and well-controlled clinical trials Gram-Positive Bacteria Corynebacterium jeikeium Enterococcus faecalis (vancomycin-resistant isolates) Enterococcus faecium (including vancomycin-resistant isolates) Staphylococcus epidermidis (including methicillin-resistant isolates) Staphylococcus haemolyticus
The effective antibiotic against Enterococcus faecium is daptomycin 2.
- Daptomycin has been shown to be active against Enterococcus faecium (including vancomycin-resistant isolates) in vitro.
- However, the efficacy of daptomycin in treating clinical infections caused by Enterococcus faecium has not been established in adequate and well-controlled clinical trials.
- Linezolid may also be effective against vancomycin-resistant Enterococcus faecium infections 3.
- It is essential to note that the clinical significance of the in vitro data is unknown, and the treatment of Enterococcus faecium infections should be guided by clinical judgment and susceptibility testing.
From the Research
Effective Antibiotics Against Enterococcus faecium
The following antibiotics have been found to be effective against Enterococcus faecium:
- Quinupristin/dalfopristin: a streptogramin that impairs bacterial protein synthesis, with a minimum concentration to inhibit growth of 90% of isolates (MIC(90)) of 2 microg/ml 4, 5, 6
- Linezolid: an oxazolidinone compound that inhibits the bacterial pre-translational initiation complex formation, with a MIC(90) of 2 to 4 microg/ml 4
- Daptomycin: an acidic lipopeptide that has been shown to be effective in combination with other antibiotics, such as quinupristin/dalfopristin 7, 8
- Tigecycline: a novel analogue of minocycline that is currently in phase II or III trials for VRE infection 4
- Oritavancin: a glycopeptide that is currently in phase II or III trials for VRE infection 4, 7
Combination Therapies
Combination therapies have also been shown to be effective against Enterococcus faecium, including:
- Quinupristin/dalfopristin in combination with ampicillin or doxycycline 4
- Linezolid in combination with rifampicin or ampicillin 8
- Daptomycin in combination with quinupristin/dalfopristin or gentamicin 8
Treatment Outcomes
The treatment outcomes for patients with Enterococcus faecium infections have been reported in several studies, with clinical response rates ranging from 65.6% to 73.6% 5, 6. The overall response rate, including both clinical and bacteriological success, has been reported to be around 65.8% 4, 5.