Treatment of Prostatitis Caused by Enterococcus Faecalis
Amoxicillin 1gm TID po is excessive and not the recommended dosage for treating prostatitis caused by Enterococcus faecalis; the recommended dose is amoxicillin 500 mg orally every 8 hours. 1
First-Line Treatment Options
- Amoxicillin 500 mg orally every 8 hours is the recommended effective treatment for chronic prostatitis caused by Enterococcus faecalis 1
- E. faecalis strains are typically susceptible to amoxicillin, making it an appropriate first-line treatment 2
- Amoxicillin is preferred over other penicillins for enterococcal infections because MICs (minimum inhibitory concentrations) are typically two to four times lower than penicillin G 1
Alternative Treatment Options
- 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 1
- For penicillin-allergic patients, vancomycin 30 mg/kg/day IV in 2 doses can be substituted 1
- 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 considered 1
Treatment Considerations for Resistant Strains
- For vancomycin-resistant E. faecalis strains, linezolid 600 mg orally every 12 hours is recommended 3
- Fluoroquinolones have shown low rates of resistance against E. faecalis causing chronic bacterial prostatitis in some studies and may be suitable alternatives 2
- Avoid tetracycline, erythromycin, and trimethoprim/sulfamethoxazole due to high rates of drug resistance in E. faecalis 2
Duration of Treatment
- Treatment for chronic bacterial prostatitis typically requires extended therapy of 4-16 weeks with an appropriate antimicrobial agent 4
- For linezolid regimens, pulse therapy (2 weeks on, 1 week off) is recommended to minimize the risk of myelosuppression and peripheral neuropathy 3
Monitoring and Follow-up
- Regular monitoring of renal function is recommended, especially if using aminoglycoside-containing regimens 1
- Patients should be monitored for potential hypersensitivity reactions to β-lactams 1
- If symptoms persist after completion of treatment, microbiological cure should be confirmed 5
Common Pitfalls and Caveats
- The recommended dose of amoxicillin is 500 mg three times daily, not 1 gram three times daily as proposed in the question 1
- Higher doses of amoxicillin (1g TID) may lead to unnecessary side effects without providing additional therapeutic benefit for susceptible E. faecalis strains 1
- Chronic bacterial prostatitis is difficult to cure due to limited antibiotic penetration into prostatic tissue 6
- Treatment failure may be due to antimicrobial resistance or biofilm formation by E. faecalis 6
- For cases refractory to multiple antibiotic treatments, alternative approaches such as bacteriophage therapy have shown promise in some case reports 6