Amoxicillin-Based Regimen for Treatment of Chronic Prostatitis Caused by Enterococcus faecalis
High-dose amoxicillin 500 mg orally every 8 hours is recommended as an effective treatment for chronic prostatitis caused by Enterococcus faecalis. 1
Primary Treatment Options
- Amoxicillin 500 mg orally every 8 hours is recommended for urinary tract infections due to E. faecalis, including chronic prostatitis 1
- For more severe infections, ampicillin 2 g IV every 4 hours combined with ceftriaxone 2 g IV every 12 hours can be used for 4-6 weeks 2
- The ampicillin-ceftriaxone regimen is effective against E. faecalis strains with and without high-level aminoglycoside resistance (HLAR) 2
- E. faecalis strains isolated from chronic bacterial prostatitis have shown 0% resistance to ampicillin and ampicillin/sulbactam, making amoxicillin an excellent choice 3
Alternative Regimens
- For aminoglycoside-susceptible strains, ampicillin 2 g IV every 4 hours with gentamicin 3 mg/kg/day IV or IM in 1 dose for 4-6 weeks can be used 1, 2
- For penicillin-allergic patients, vancomycin 30 mg/kg/day IV in 2 doses can be substituted 1, 2
- Fluoroquinolones (levofloxacin or ciprofloxacin) may be considered as they show relatively low resistance rates against E. faecalis (4.8% for levofloxacin, 9.7% for ciprofloxacin) 3
Duration of Therapy
- Treatment duration for chronic prostatitis caused by E. faecalis should be a minimum of 4 weeks 4
- For more severe or complicated cases, extending treatment to 6 weeks may be necessary 2
- Shorter courses are associated with higher relapse rates due to the limited penetration of antibiotics into prostatic tissue 5
Monitoring and Follow-up
- Regular monitoring of renal function is recommended, especially if using aminoglycoside-containing regimens 2
- Follow-up cultures of expressed prostatic secretions should be performed after completion of therapy to confirm eradication 3
- Patients should be monitored for potential hypersensitivity reactions to β-lactams 2
Important Considerations and Pitfalls
- The lipid solubility of the antibiotic is the most important determinant of prostatic tissue penetration in chronic prostatitis 5
- Traditional teaching suggests that penicillins do not penetrate well into chronically inflamed prostatic tissue, but clinical evidence supports their efficacy against E. faecalis 5, 3
- Avoid tetracycline, erythromycin, and trimethoprim/sulfamethoxazole for E. faecalis prostatitis due to high resistance rates (97.5%, 95%, and 31.5% respectively) 3
- If the patient develops hypersensitivity to amoxicillin, alternative regimens such as vancomycin may be necessary 2
Special Situations
- For recurrent infections, longer treatment courses (up to 3 months) may be required 5
- In cases of treatment failure with conventional antibiotics, experimental approaches such as phage therapy have shown promising results for eradication of E. faecalis in chronic prostatitis 6
- For patients with concomitant urinary symptoms, adding an α-blocker may help manage symptoms while treating the underlying infection 4