From the Guidelines
Linezolid is the most appropriate oral antibiotic treatment option for Enterococcus faecalis infections, given its excellent bioavailability and activity against Enterococcus species, including vancomycin-resistant Enterococcus (VRE) 1. When considering treatment options for Enterococcus faecalis infections, it is essential to prioritize morbidity, mortality, and quality of life as outcomes.
Key Considerations
- The choice of oral antibiotic should be based on susceptibility, potential drug-drug interactions, or contraindications to a specific agent 1.
- Linezolid has a toxicity profile that may limit long-term use, including bone marrow suppression and neuropathies 1.
- Amoxicillin is not the best option due to its lower bioavailability compared to linezolid 1.
Treatment Options
- Linezolid 600 mg twice daily is a suitable option for Enterococcus faecalis infections, considering its excellent bioavailability and activity against Enterococcus species 1.
- Other options like pristinamycin may not be effective against Enterococcus faecalis due to high rates of resistance 1.
Important Notes
- Antimicrobial choice should be based on susceptibility, potential drug-drug interactions, or contraindications to a specific agent 1.
- The patient's wishes and the possibility of further surgery should be considered when deciding on a treatment plan 1.
From the FDA Drug Label
Infections of the Genitourinary Tract: Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Escherichia coli, Proteus mirabilis, or Enterococcus faecalis Vancomycin-resistant Enterococcus faecium infections, including concurrent bacteremia... 600 mg IV or oral q12h... 14 to 28
The oral antibiotic treatment options for Enterococcus faecalis infections are:
- Amoxicillin (PO), for β-lactamase–negative isolates 2
- Linezolid (PO), although the label specifically mentions Vancomycin-resistant Enterococcus faecium infections, it does not explicitly exclude Enterococcus faecalis 3
From the Research
Oral Antibiotic Treatment Options for Enterococcus faecalis Infections
- The treatment of Enterococcus faecalis infections often involves a combination of antibiotics, with ampicillin being a common choice 4, 5, 6.
- Ceftobiprole has been shown to be effective in combination with ampicillin for the treatment of E. faecalis infections, with a high clinical success rate and microbiological cure rate 5, 6.
- Linezolid has also been studied as an alternative for prophylaxis of experimental endocarditis due to vancomycin-susceptible and vancomycin-resistant E. faecalis, but its efficacy is lower compared to amoxicillin 7.
- Amoxicillin has been shown to be highly effective in preventing experimental endocarditis due to E. faecalis, with a single dose providing 100% protection against all tested isolates 7.
- The combination of ampicillin and ceftobiprole has been evaluated in several studies, with results showing that it can be an effective treatment option for E. faecalis infective endocarditis and bloodstream infection 5, 6.
Key Findings
- The use of ampicillin plus ceftobiprole combination therapy has been associated with high clinical success rates and microbiological cure rates in patients with E. faecalis infections 5, 6.
- Therapeutic drug monitoring (TDM) can help optimize the treatment of E. faecalis infections with ampicillin and ceftobiprole 5, 6.
- The mechanism of dual beta-lactam therapy relies on the saturation of penicillin-binding proteins (PBPs), and ceftobiprole exhibits high affinity binding to nearly all E. faecalis PBPs 6.