Ceftin (Cefuroxime) Does NOT Treat Enterococcus Infections
Cefuroxime and all cephalosporins are intrinsically inactive against Enterococcus species and should never be used as monotherapy for enterococcal infections. 1, 2
Why Cefuroxime Fails Against Enterococcus
Enterococci possess intrinsic resistance to all cephalosporins, including cefuroxime, due to their low-affinity penicillin-binding proteins that cephalosporins cannot effectively bind. 3
Using cefuroxime alone for Enterococcus infections will result in treatment failure and potentially worsen patient outcomes. 1
While cefuroxime has excellent activity against streptococcal strains, it specifically excludes enterococci from its spectrum of coverage. 3, 4
Assuming all gram-positive cocci respond to cephalosporins is a critical clinical pitfall—enterococci are the notable exception. 1
Appropriate Treatment Options for Enterococcus
First-Line Therapy
Ampicillin or amoxicillin remains the drug of choice for Enterococcus faecalis infections, with clinical eradication rates of 88.1%. 2
For urinary tract infections specifically, ampicillin or ampicillin-sulbactam should be used as first-line IV therapy. 1
Alternative Agents
Vancomycin is appropriate for ampicillin-resistant strains or patients with severe beta-lactam allergies. 1, 2
Nitrofurantoin is FDA-approved specifically for E. faecalis UTIs with resistance rates below 6%. 2
Fosfomycin (3g oral single dose) is FDA-approved for uncomplicated E. faecalis UTIs. 2
Serious Infections Requiring Bactericidal Therapy
- For endocarditis or other serious infections, ampicillin must be combined with either gentamicin or ceftriaxone to achieve synergistic bactericidal activity. 2, 5
When to Consider Enterococcal Coverage
High-Risk Scenarios Requiring Empiric Coverage
- Healthcare-associated intra-abdominal infections 6, 2
- Postoperative infections 2
- Patients previously treated with cephalosporins 2
- Immunocompromised patients 2
- Valvular heart disease or prosthetic intravascular materials 2
Low-Risk Scenarios
- Empiric enterococcal coverage is NOT necessary for community-acquired intra-abdominal infections in immunocompetent patients. 6
Critical Clinical Pitfalls to Avoid
Never continue cefuroxime monotherapy after culture results identify Enterococcus as the causative pathogen. 1
If using cefuroxime-based regimens for mixed infections in high-risk patients, ampicillin must be added to provide enterococcal coverage. 2
Always obtain susceptibility testing before initiating therapy, as resistance patterns vary significantly by institution. 2