What antibiotic is recommended for treating Enterococcus faecalis (E. faecalis) urinary tract infection (UTI)?

From the Guidelines

Fosfomycin is the recommended antibiotic for treating Enterococcus faecalis (E. faecalis) urinary tract infection (UTI).

Treatment Options

• Fosfomycin is FDA approved for the treatment of UTI caused by E. faecalis and has in vitro activity against VRE infections 1.
• A single dose of fosfomycin 3 g PO is recommended for uncomplicated urinary tract infections due to VRE 1.
• Other options include:
  • Nitrofurantoin 100 mg PO every 6 h 1
  • High dose ampicillin (18-30 g IV daily in divided doses) or amoxicillin 500 mg PO/IV every 8 h daily 1

Important Considerations

• It is essential to differentiate colonization from true infection prior to empiric prescription of anti-VRE antimicrobial agents 1.
• The treatment duration and choice of antibiotic may depend on the site of infection, clinical response, and individual patient factors 1.

From the Research

Antibiotic Treatment Options for E. faecalis UTI

• For uncomplicated E. faecalis UTI, the following antibiotics are recommended:
  • Amoxicillin 2, 3
  • Nitrofurantoin 2, 4, 5
  • Fosfomycin 2, 4, 5
• For complicated E. faecalis UTI, the following antibiotics may be considered:
  • Aminopenicillins (e.g., ampicillin) in combination with aminoglycosides (e.g., gentamicin) 3
  • Daptomycin 2, 4
  • Linezolid 2, 4, 5
• It is essential to note that the choice of antibiotic should be guided by urine culture and susceptibility results 4
• Ciprofloxacin is not recommended for E. faecalis UTI due to high resistance rates 6

Resistance Patterns and Antibiotic Susceptibility

• E. faecalis strains have shown low resistance to antibiotics such as ampicillin and vancomycin 3, 6
• However, high resistance rates have been reported for erythromycin and tetracycline 6
• Vancomycin-resistant E. faecalis isolates are susceptible to linezolid, ampicillin, and nitrofurantoin 5