Best Treatment for Enterococcus Infection on the Epidermis
For Enterococcus infections on the epidermis (skin), ampicillin is the first-line treatment when the organism is susceptible, with vancomycin as the alternative for resistant strains or in penicillin-allergic patients. 1
Initial Treatment Approach
- Ampicillin or amoxicillin should be used as first-line therapy for susceptible Enterococcus faecalis infections on the skin 1
- For penicillin-allergic patients or when resistance is suspected, vancomycin is the recommended alternative 1, 2
- Piperacillin-tazobactam is another effective option for Enterococcus infections, particularly in polymicrobial skin infections 1, 2
- Daptomycin is FDA-approved for complicated skin and skin structure infections caused by Enterococcus faecalis (vancomycin-susceptible isolates only) 3
Treatment Based on Resistance Pattern
For Susceptible Enterococcus:
- Ampicillin or amoxicillin is the preferred treatment due to excellent efficacy and safety profile 1, 4
- For uncomplicated skin infections, oral therapy may be sufficient after initial response 2
For Resistant Enterococcus:
- Vancomycin for ampicillin-resistant but vancomycin-susceptible strains 1, 2
- Linezolid or daptomycin for vancomycin-resistant Enterococcus (VRE) skin infections 4, 5
- Tigecycline has demonstrated efficacy against Enterococcus faecalis in skin infections with a clinical cure rate of 71.4% 6
Special Considerations
- For immunocompromised patients, broader empiric coverage may be necessary until culture results are available 1
- In healthcare-associated infections, empiric anti-enterococcal therapy is recommended, particularly for patients who have previously received cephalosporins 2, 1
- Cephalosporins should be avoided as monotherapy for Enterococcus infections due to intrinsic resistance 7, 8
- For polymicrobial infections involving Enterococcus on the skin, combination therapy may be necessary to cover co-infecting organisms 2, 9
Treatment Duration
- For uncomplicated skin infections: 7-10 days of appropriate therapy is typically sufficient 1
- For complicated skin infections: 10-14 days of therapy is recommended 2
- Clinical response should guide duration, with resolution of erythema, warmth, and swelling indicating successful treatment 2
Common Pitfalls to Avoid
- Failure to obtain appropriate cultures before initiating antibiotics can lead to inadequate treatment 2
- Using cephalosporins alone for Enterococcus infections is ineffective due to intrinsic resistance 7, 8
- Underestimating the importance of Enterococcus in polymicrobial skin infections can lead to treatment failure 9
- Delayed recognition of vancomycin-resistant Enterococcus requiring alternative agents like linezolid or daptomycin 4, 5
By following these evidence-based recommendations, clinicians can effectively treat Enterococcus infections on the epidermis while minimizing the risk of treatment failure and antimicrobial resistance.