Treatment Duration for Uncomplicated Enterococcus faecalis UTI with Amoxicillin
Amoxicillin 500 mg orally three times daily for 7 days is the recommended treatment duration for uncomplicated Enterococcus faecalis UTI. 1, 2
First-Line Treatment Options
- Amoxicillin 500 mg orally every 8 hours for 7 days is the first-line therapy for uncomplicated E. faecalis UTIs that are pansensitive 1
- Ampicillin 500 mg orally every 8 hours for 7 days is an equivalent alternative to amoxicillin 1
- Both amoxicillin and ampicillin achieve high clinical (88.1%) and microbiological (86%) eradication rates for E. faecalis UTIs 1
Alternative Treatment Options
- Nitrofurantoin 100 mg orally every 6 hours for 7 days is an effective alternative with good in vitro activity against E. faecalis and low resistance rates (below 6%) 1, 3
- Fosfomycin 3 g as a single oral dose is FDA-approved specifically for E. faecalis UTIs and provides convenient single-dose therapy 1, 4
- Fosfomycin demonstrates high activity against common UTI pathogens including E. faecalis 4
Treatment Considerations
- Confirm susceptibility testing before initiating therapy, even for strains described as "pansensitive" 1
- Avoid fluoroquinolones due to high resistance rates (46-47% for ciprofloxacin/levofloxacin) and FDA warnings about unfavorable risk-benefit ratios for uncomplicated UTIs 1, 5
- For beta-lactamase producing strains, consider replacing amoxicillin with amoxicillin-clavulanate for 7 days 2
Common Pitfalls and Caveats
- Underdosing amoxicillin should be avoided - ensure the full 500 mg three times daily dosing 2
- Fluoroquinolones (ciprofloxacin) are no longer recommended therapy for E. faecalis UTI due to increasing resistance rates, particularly in men with risk factors such as hospital-acquired infection or recent healthcare center transfer 5
- Routine therapy for asymptomatic bacteriuria with E. faecalis is not recommended 6
- If a urinary catheter is present, consider removal as part of the management strategy 6
Special Populations
- For patients with penicillin allergy, nitrofurantoin 100 mg orally every 6 hours for 7 days is an appropriate alternative 2
- For vancomycin-resistant E. faecalis strains, consider alternative agents such as linezolid or daptomycin based on susceptibility testing 6
- For complicated UTIs or pyelonephritis, longer treatment durations may be necessary, but specific evidence for E. faecalis is limited 7