Treatment of Enterococcus Faecalis Chronic Prostatitis with Moxifloxacin or Linezolid
Linezolid is the preferred treatment for Enterococcus faecalis chronic prostatitis with an eradication rate of approximately 86.4% microbiologically and 81.4% clinically, while specific eradication rates for moxifloxacin in this condition are not well documented in the available evidence. 1, 2, 3
First-Line Treatment Options
- Linezolid 600 mg orally every 12 hours is strongly recommended (strength of evidence 1C) for enterococcal infections including chronic bacterial prostatitis caused by E. faecalis 1, 2, 3
- For pulse therapy, consider administering linezolid for 2 weeks, followed by a 1-week rest period to minimize the risk of myelosuppression and peripheral neuropathy 2
- Linezolid has demonstrated high clinical and microbiological cure rates (86.4% and 81.4%, respectively) in enterococcal infections 1, 3
- Linezolid is particularly effective against both vancomycin-susceptible and vancomycin-resistant E. faecalis strains 1, 2
Fluoroquinolone Considerations
- While moxifloxacin-specific data for E. faecalis prostatitis is limited, other fluoroquinolones show variable resistance patterns in E. faecalis prostatitis 4
- E. faecalis strains isolated from chronic prostatitis patients have shown resistance rates of 9.7% to ciprofloxacin, 4.8% to levofloxacin, and 26.8% to norfloxacin 4
- Fluoroquinolones generally have good prostatic penetration but may have limited efficacy against E. faecalis compared to linezolid 3, 4
Treatment Duration and Monitoring
- Extended treatment with linezolid may be necessary based on clinical response and follow-up cultures 2, 3
- Consider 2-3 cycles of pulse therapy for chronic prostatitis to achieve complete eradication 2
- Follow-up cultures should be obtained 1-2 weeks after completion of therapy to confirm eradication 3
- Monitor for potential adverse effects of linezolid, particularly with extended treatment courses:
Alternative Treatment Options
- For patients unable to tolerate linezolid, high-dose daptomycin (8-12 mg/kg/day) may be considered, though it has less evidence for prostatitis specifically 1, 2, 3
- Daptomycin in combination with β-lactams may be effective for vancomycin-resistant enterococcal infections 1
- For uncomplicated urinary tract infections due to E. faecalis (not prostatitis), options include:
- Single dose fosfomycin 3 g orally
- Nitrofurantoin 100 mg orally every 6 hours
- High-dose ampicillin (18-30 g IV daily in divided doses) or amoxicillin 500 mg orally/IV every 8 hours 1
Special Considerations
- E. faecalis is intrinsically resistant to quinupristin-dalfopristin (100% resistance), limiting treatment options 1, 4
- High resistance rates have been observed for tetracycline (97.5%), erythromycin (95%), and trimethoprim/sulfamethoxazole (31.5%) in E. faecalis isolates from prostatitis 4
- Chronic bacterial prostatitis typically requires extended therapy (4-16 weeks) due to limited antibiotic penetration into prostatic tissue 5, 6
- In cases of treatment failure, consider prostatic imaging to rule out abscess formation or calcifications that may harbor bacteria 3